Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Verification of Patient Insurance Coverage
With the New Year comes new insurance coverage for many patients. It is estimated that over one million people will have a new insurance plan as a result of the health insurance exchanges created under the Patient Protection and Affordable Care Act (ACA). Due to the numerous problems experienced with the enrollment process, patients may present at your office without insurance cards.

You can verify their coverage if the marketplace in your state is run by the Federal government by calling their plan’s customer service line. A fact sheet and a list of all plans and their customer service numbers can be found at www.marketplace.cms.gov/...pdf. If you cannot find the number, call the Marketplace Call Center at 1-800-318-2596. If your state runs its own health insurance exchange, contact your state exchange. To find the website and contact information for your state exchange, visit https://www.healthcare.gov/marketplace/individual/#state=alabama and choose your state. It is important to note that if the patient is uninsured, they have until March 31st to sign up for non-employer based coverage. Additional general information for you and your patients is available at www.marketplace.cms.gov/.