Regulatory: Reduce denials, service gaps 

Q. How can suppliers find out when patients switch to Medicare Advantage Plans? 

A. Because many patients forget to notify DME suppliers directly, denials from an inactive plan are often the first sign that a patient has changed insurance coverage. Fortunately, Medicare eligibility data is a powerful tool for identifying policy changes in advance. Search results include effective dates for plans that go into effect up to four months after the date of service queried. 

A structured, year-end approach to checking Medicare eligibility data can significantly reduce denials and service gaps in the new year related to Medicare Advantage Plan (MAP) changes. Most plan changes occur during the open enrollment period between Oct. 15 and Dec. 7. During this time, beneficiaries may switch between different MAPs, as well as to and from Medicare fee-for-service (FFS). New coverage begins on Jan. 1, 2022, for any beneficiary that elects to make a change.  

To identify patients slated to change coverage, compile a list of existing patients with Medicare coverage, including those already enrolled in MAPs. Then, using the batch eligibility tools available in billing software or the MAC web portals, query Medicare data and isolate results with active and future MAP enrollments. Use the original Medicare fee-for-service (FFS) MBI number for searches, not MAP policy numbers.  

The accuracy of Medicare eligibility data depends on how quickly the MAPs update CMS records after an enrollment change. While the database refreshes daily, it may take a few days before new policy data is visible.  

Andrea Stark is the founder and head of reimbursement at MiraVista, LLC. You can reach her at [email protected].