Ensuring Accurate Registration and Billing for Managed Medicare, Medicaid, and IPA Patients 

Jen Johnson, RCM Operations Manager Senior, Experity

Front desk employees play a crucial role in ensuring a smooth registration process for patients with Managed Medicare, Medicaid, and Independent Physician Associations (IPAs). Proper registration is essential for accurate billing, reducing claim denials and rejections. Below are key guidelines to help front desk users navigate the complexities of verifying and billing the correct insurance plans. 

1. Verify Insurance Eligibility at Every Visit

Insurance plans can change frequently, often without patients realizing it. Patients may switch from one Medicare/Medicaid Managed Care plan to another or from one IPA to another IPA, affecting how their visit should be billed. To avoid claim denials: 

• Always ask for the patient’s insurance card at every visit, even if they have been seen before. 

• Always verify eligibility utilizing the appropriate eligibility verification tools (payer portals, clearinghouses, or insurance websites) to confirm active coverage, 

• Always confirm primary and secondary insurances to ensure claims are submitted correctly. 

2. Identify and Bill the Correct Plan

Managed Medicare, Medicaid, and IPAs have specific billing requirements, and submitting claims to the wrong entity can lead to rejections or delays. 

• Medicare Advantage Plans: Patients with Managed Medicare (Medicare Advantage) are no longer billed under traditional Medicare (Part A & B). Instead, these plans are administered by private insurers such as Humana, UnitedHealthcare, or Aetna. Ensure the correct plan is listed and billed. 

• Managed Medicaid Plans: Many states require Medicaid beneficiaries to enroll in a Managed Care Organization (MCO). Registrars must confirm if the patient is under traditional Medicaid or a Managed Medicaid plan. 

• IPA Plans: Some patients belong to an IPA, which may require specific authorization or referrals. Ensure that visits are within the network and that billing follows the IPA’s protocols.

3. Document Accurately and Update Records

Proper documentation reduces billing errors and enhances patient satisfaction. 

• Update the patient’s insurance details in the system every time they visit. 

• Scan and attach copies of insurance cards to the patient’s file. 

• Ensure demographic details (such as address and phone number) are current, as changes may impact eligibility verification. 

Conclusion 

Accurate patient registration and eligibility verification are critical in ensuring a smooth billing process for urgent care visits. By diligently checking insurance information and billing the correct plan can help reduce claim denials, improve efficiency, and enhance the patient experience. Remember, every visit requires an insurance check—never assume the patient’s plan has remained the same.