Billing Reminders for the New Year – Part 1

Eligibility & Benefits:
With a new year comes new insurance policies for patients across the country. It is important to remember that many patients change plans at the start of a new year so verifying benefits and eligibility is a must. While some patients keep the same insurance plans, many do not, so utilizing online eligibility and benefits tools is both fast and efficient. Eligibility can be checked on websites like Availity and NaviNet or by calling the provider phone number on the back of the insurance card.
When checking eligibility, always make sure to use the patient’s name exactly how it is listed on the member identification card. This is especially important with Medicare. Medicare will reject or deny the claims as “member not found” or “cannot identify member as insured.”

MCO & HMO Coverage:
Patients often opt into Medicare Advantage plans. Medicare Advantage plans replace the Medicare Part B coverage. Some of the most commonly used advantage plans are UnitedHealthcare, BlueCross BlueShield, Aetna and Humana. There are numerous others, so always make sure to double check the patient’s member ID card. The insurance card will say “Medicare” somewhere on it.  These plans serve as the patient’s Medicare insurance and Medicare Part B will not be billed. If there is ever uncertainty about whether or not a patient’s Medicare insurance is an advantage plan, using Availity or the Medicare websites will give you the correct insurance plan information.


About PGM

Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States.  For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories.  PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, General Surgery, Vascular Surgery, Plastic Surgery, and many more.  PGM’s medical billing and practice management solutions include:                –