Identifying and verifying the beneficiaries of Medicare

Identification of Medicare Beneficiaries 

When an individual becomes entitled to Medicare, he or she receives a health insurance card. This card contains important information that must be included on all claims submitted by providers:
Name
Sex
Health Insurance
Claim (HIC) number
Effective date of entitlement to hospital (Part A) insurance
Effective date of entitlement to medical (Part B) insurance

Most Medicare beneficiaries receive health insurance cards issued by CMS; however, the Railroad Retirement Board (RRB) issues a Medicare card to individuals eligible for Medicare Railroad Re- tirement benefits.

CMS-Issued Medicare Cards 

Medicare cards issued by CMS typically reflect the Social Security Number (SSN) of either the in- sured or a spouse (possible divorced or deceased) depending on the wage earner upon whose earn- ings eligibility is based. An added alpha or alphanumeric suffix denotes the category of eligibility including those who are required to pay monthly premiums for Part A coverage.

RRB-Issued Medicare Numbers 

Medicare numbers issued by the RRB may be the insured ’ s SSN or a six-digit number (zeros may be added at the beginning to bring it to nine digits). Regardless of the length of the number, the in- sured ’ s number will always have an alpha prefix (with one or more characters). For example, H000- 000 or H000-000-000 would be a railroad pensioner (by age or disability).

Verifying Beneficiary Eligibility

Eligibility for Social Security benefits is the basis for Medicare eligibility for most patients. The eli- gibility source can be determined by asking to see the patient ’ s Medicare card. Maintaining a photo- copy of the card in the patient ’ s file may prevent errors. Failure to record on a claim the beneficiary ’ s name and identification number exactly as they appear on the Medicare card may result in a payment denial or claim delay. The physician ’ s office should develop a process to regularly verify Medicare insurance information and update patient records to reflect current information.

Note: Due to an increase in lost and stolen Medicare cards, verifying and copying a patient ’ s picture identification is suggested to ensure the patient is eligible to receive benefits. If Medicare pays a claim for services rendered to a non-Medicare-eligible beneficiary, a refund request may be gener- ated.

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