Medicare eligibility scenario at the time of each

patient then can come back to have the test performed.
Medicare Eligibility Scenario
At the time of each visit, the registrar needs to check the patient’s Medicare eligibility. The
registrar needs to perform four tasks to validate eligibility on the initial encounter and
periodically during subsequent visits. Name the tasks and indicate one reason why each
step is important.
1. Copy patients Medicare card: Check patient’s information and verify patient’s
exact name, claim number, including numbers and letters, type of coverage. If the
patient is coming to the office, make sure the patient has part B coverage. Check
for effective dates. Verify the beneficiary number and make sure that the number
is right when checking the eligibility information this is what Medicare
recommends just in case the patient switched from classic Medicare to any
advantage plans and perhaps we are not contracted with them.
2. Copy Driver License or ID: this is necessary to make sure the patient’s identity
is valid. Make sure that the information on the patients Medicare card is the same
as the ID or Driver license presented. Do this to avoid any fraud actions.
3. Obtain patients signature : to validate patient’s identity, this allows us to bill
Medicare on their behalf.
4. Determine Primary and Secondary Payers: find out if the patient has any
supplemental insurance or secondary insurance. As we know Medicare covers only
80% so we want to know who will be responsible for the remaining 20 % of the
balance. Should we bill another insurance or will the patient be fully responsible
for the last 20%.