November 7, 2016

Open Enrollment Means Benefits Verification Time Is Here

By Janet Potter, Senior Manager, Advisory Services

Open Enrollment Means Benefits Verification Time Is Here

Open enrollment for Medicare beneficiaries runs each year from October 15 through December 7. The weeks following open enrollment are even more critical for Medicare providers. It is vitally important that all Medicare providers verify the benefits of all their Medicare patients following open enrollment. During this time period, beneficiaries can switch between traditional Medicare and Medicare Advantage (MA), or change MA plans. Prior to the first patient encounter in 2017 (or the first of January for institutional providers or others who bill on a monthly basis), benefits should be verified to determine the correct payer source. If a Medicare provider is not in network with a Medicare Advantage plan, they cannot bill and be paid for services provided to the plan’s enrollees. Many MA plans have different prior approval requirements and coverage criteria, which need to be followed by providers in order to be paid for services. Ignoring benefits verification steps can result in lost revenue.

If you have questions regarding steps to take to verify benefits, or about Medicare and Medicare Advantage in general, please contact your Marcum advisor.

Related Industry