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This Monday Minute will touch on the significance of Medicare Eligibility Verifications and a key update to the content of Workers’ Comp and Liability Policies in the Common Working File.

Hello, everyone and welcome to our Monday Minute. Today I would like to discuss with you Medicare Eligibility Verifications and honestly, the verification of coverage. We’re in mid-September and beginning to swiftly approach the open enrollment period for Medicare patients, which will run from mid-October through the first week of December. During this open enrollment period, patients cannot only enroll in Medicare, but they can also make changes from traditional Medicare to Medicare Advantage, switch their Medicare Advantage plan, switch their Medicare Advantage provider or organization. There’re tons of things that can transpire during that period. Obviously, the change or updates that they make will not take place until January 1, 2022, but it’s something you should be heightened aware, is happening and happening soon. So, as we approach January, what’s the big deal, the big deal is, you should be checking Medicare Eligibility Verification, for every single patient that you have on service that is the age 65 years or older, to ensure that you have the appropriate payer moving forward on January 1.  I would check the eligibility for every patient you have on service, regardless of the payer, at least once a week, in the month of January. Many of you have EMR systems that are checking that for you daily or once a week, or whatever the case may be. As long as you are comfortable that those systems are appropriately checking the status, then you should be good to go.

I do want to point out something that we have discovered, that could be a significant help in situations where you do that Eligibility Verification, and you discover that the patient has a workers’ comp policy. For example, if you file that Medicare final client, and it comes back and says this patient is not primary Medicare, and it’s because of this workers’ comp policy. Typically, the problem is that you have a diagnosis code on your Home Health claim, that is the same as the diagnosis code that the patient was on workers’ comp for.  What Medicare is going to instruct you to do, assuming that this claim has nothing to do with that workers’ comp policy, they’re going to tell you to take that diagnosis code off of your Medicare claim, and then it will process and pay. And so what they’ve done now, which is the exciting part of this, when you check the Eligibility Verification and you see that there’s a workers’ comp policy on a patient’s account, they are giving you the diagnosis code, that if you put that code on your Medicare claim, you’re not going to get paid, it’s going to reject as a workers’ comp policy. The same is true for liability policies. If you do a Medicare Eligibility Verification, you discover that the patient has an open workers’ comp or open liability policy and you see the diagnosis code, which should now be present, make sure that your Home Health claim does not include that diagnosis code. It can be primary, it can be secondary, if it includes the code, the claim is going to reject saying that Medicare is not the primary payer.  They’re going to instruct you to remove that diagnosis code, and you will then be able to get your Medicare claim to process. We were very excited to discover that those diagnosis codes are now being listed on those workers’ comp and liability policies.

In addition to Medicare, I just want to stress that as we move into a new year, whether the patient is Medicare or not, commercial payers change all the time. My company, our personal health insurance policies for our staff change at least every other year, if not every year, and that will go into effect in January. Checking that eligibility and verifying the coverage of a patient is extremely important for all patients you have with all payers as we move into a new calendar year. I know this seems a little early for that, but I wanted to make sure that we had the conversation and that you were heightened aware of the workers’ comp and liability policy situation so that if you’ve been getting rejections, because of that, you’ll be able to see that up front now, and more expeditiously get your Medicare claims to pay.

Thank you all for joining us today. Thank you for being those amazing Home Health and Hospice providers taking care of patients during this public health emergency. I hope you all have a fabulous week, and we will talk again soon.