Medicare eligibility verification

Overcoming the challenges of Medicare eligibility verification

What makes traditional Medicare eligibility verification so time-consuming? Using the system known as Medicare Direct Data Entry or DDE, you can literally spend hours checking a patient’s history of Medicare coverage. For one thing, it’s an understatement to say that DDE isn’t very user-friendly. The interface is an old-style “green screen” – just like every computer 20 or 30 years ago! With this system, you need to access several sections of the DDE in order to get all of the relevant information for a patient for whom you are verifying Medicare eligibility. The information is not consolidated in one section.

Then, the process must be repeated for each patient. The system is not set up to handle multiple inquiries at once.

And that’s just the first time you verify Medicare eligibility for a patient, usually upon admission to your clinic or program. There are several other times that you should re-verify, including prior to submission of any claim. At those times, the same time-consuming process is repeated. If a patient’s eligibility status or insurance coverage changes, and you haven’t picked up on the change, it can mean costly delays. You may have submitted a claim to the wrong insurer, it was rejected, and now you need to re-submit the same claim to the correct payer.

Whether you’re a single provider seeing just a few Medicare patients or a busy clinic or home health agency with a Medicare clientele, spending too much time on traditional eligibility verification can negatively impact on your bottom line.

3 ways technology can improve your Medicare eligibility verification process

These days, many providers turn to technology to save wear and tear on their staff, AND speed up their organizational cash flow. Here’s how it can help:

1. Automate all the manual, time-consuming processes and avoid the “green screens” associated with digging through DDE for Medicare eligibility verification. Software from ABILITY Network does the searching for you, and returns all the information you want – even for multiple inquiries – right at the time of admission, so there’s no surprises later. Maybe best of all, ABILITY software provides a “Windows-look” interface – no more navigating multiple DDE/FISS screens. With the time you’ll save, you can concentrate on other pressing revenue management issues.

2. Speed up your reimbursement cycle and get improved cash flow. Technology can help billers verify eligibility information, find billing errors, perform drill-down searches, and get critical information about patients with minimal manual processes. If you’ve ever had a claim delayed or rejected because you missed a change in eligibility, you know how much revenue you can save using software that will automatically alert you to these changes.

3. Go beyond verification: get a better handle on your overall revenue picture. A Medicare revenue management tool like ABILITY | EASE can generate detailed, daily reports to help you more easily keep your revenue on track. Without it, you or your staff are saddled with manually compiling the information. These automated reports are not only there to help you manage a more predictable cash flow, they are absolutely priceless during an audit.