This post is based on our recent webinar “Ensuring Medicare Eligibility as Part of Your Hospice RCM Process.” Watch the on-demand recording here.
There’s no easy button when it comes to managing reimbursement in a hospice organization, but it’s a process that must be managed, maintained and controlled by trained, competent staff. An incredibly important part of managing the reimbursement process is ensuring Medicare eligibility. Medicare Part A covers hospice care from a Medicare-approved hospice agency for two 90-day periods and unlimited 60-day periods (with recertifications). With patients relying heavily on their coverage being eligible, you’ll want to make sure that your organization can ensure insurance validity.
Consider these three tips for ensuring Medicare eligibility and a smoother hospice reimbursement process for your organization:
1. Use a Medicare Patient Eligibility Checklist
It’s very important to develop a process for ensuring Medicare eligibility. Whatever process your hospice organization utilizes, consider documenting it because often, people who were trained to manage this process may leave or retire. Having the process and its key components detailed will also be a big help when you’re looking to retrain current employees and new hires.
The patient intake, verification of benefits, insurance eligibility, and prior authorizations requirements are the important functions that comprise the eligibility process and should be considered when designing it. Developing a patient eligibility checklist will ensure the understanding of those managing the process.
Listed below are a few practices to consider when designing yours:
- Verify patient Medicare Beneficiary Identifier (MBI)
- Verify Medicare Part A entitlement effective date and termination date
- Verify patient name and date of birth
- Determine if the patient has other primary insurance
- If Medicare is not primary, verify hospice benefits with patient primary insurance
Checking for coverage is essential, especially regarding patients with Medicare with additional coverage. Identifying and verifying the patient’s coverage will ensure claims are sent to the appropriate payer and reimbursement is not impacted.
2. Use the Right People for the Job
It’s important to never underestimate the significance of having good, well-trained, and prepared people managing the eligibility process of verifying benefits, authorizations, and coverage for your patients. Not having the correct or most appropriate people managing this area can cause delays in treatment and reimbursement, affecting the patient and the business’ front-end revenue cycle. That’s why it’s a must that people managing this process have a basic understanding of Medicare and insurance.
Consider asking yourself these questions when evaluating your hospice organization:
- Do I have enough people to cover this process?
- Do I need to procure talent outside the organization?
- Is my staff properly trained? Do they have the resources they need?
Every part of the eligibility process must be accounted for and if your organization feels they are low on staff in certain areas, consult with your team, and consider hiring outside talent. This solution doesn’t have to be a long-term model, but rather a supplemental, short-term model to help get through a project or training for staff.
3. Use Technology to Check Eligibility
The technology available today makes checking patient eligibility through electronic medical records easier than ever. And with technology comes automation, meaning less time spent on manual work and more time helping others. If your organization isn’t already using one, consider exploring an EMR that can verify hospice eligibility and streamline management duties in a clear and accurate fashion.
Using a clearinghouse is another great tool to help with identifying hospice eligibility. Keep in mind, a good clearinghouse should look for multi-payer eligibility and have the capacity to look through multiple sources to uncover eligibility that may not have previously been identified. Some also have advanced eligibility options for exception reporting and tools for denial management.
Learn more about Optima Hospice and its Revenue Cycle Services.
