Frequently Asked Questions-Medicaid Verification Q: Do all Medicaid covered patients have Medicare as primary? A: No, Medicare is an age-based federal health insurance program for individuals 65 and over (some younger if disabled) while Medicaid is a state based public assistance program for needy individuals of all ages. If a patient qualifies for both Medicare…
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Coverage and Benefits For a clinic to run efficiently, the staff must be familiar with the terms Summary Plan Documents (SPD); Summary of Benefits and Coverage (SBC); Payer Medical Review Policy (MRP); Payer Reimbursement Policy; Policy Guidelines; Payer Clinical Guidelines, and the Provider Manual. The mini-class titled MRP-What Does It Mean to Me? provides a…
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This tutorial provides tips and tricks for the clinic to master the verification process. The staff member will learn how to use the verification template for gathering information that can assist with reimbursement. We even provide a peek at the many resources a clinic can find online via payer portals that help the clinic avoid…
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Don’t Forget to Verify Insurance Insurance Verification is a simple step that provides a clear picture of who is responsible for what portion of patients’ charges. Collect the patients’ insurance information from the first phone call so that by their first visit, insurance coverage is understood, and patient responsibility can be calculated based on the…
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Why Insurance Verification This quick tutorial explains why insurance verification is an important piece of the financial report of findings (FROF) with the patient. It contains the top tips to make the verification process simple and effective by reviewing the variety of tools available in the KMC University Library. This image provides a sampling of…
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