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Identifying Medicare Patients

MEL, SQL, Oracle

Last Post by Anonymous 1 second ago

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bhoover

(@bhoover)

Posts: 360

Honorable Member

Topic starter

Hello All,

I am curious how people identify Medicare patients in MEL code. There are two ways that I do this right now, neither of which I think is completely satisfactory.

Option1: Use INS_NAME() and check for 'Medicare' as their insurance. I also need to check against a list of Medicare advantage plans. The downside to this is keeping the Medicare advantage insurance list up to date. Also since we work with multiple practices there is variation in naming in billing and the plans listed from practice to practice.

Option 2: Assume that if a patient is >=65 years old they are a Medicare patient. This much more straightforward, however you will incorrectly identify some patients who for various reasons are not Medicare patients despite their age.

Does anyone have another option that they use?

Thanks,

Brad

Posted : November 2, 2017 1:26 am

gpincomb

(@gpincomb)

Posts: 278

Reputable Member

We currently have a form that uses the following for a Visibility region. It uses the "find" function which looks in the MLDEFS*.TXT files. This does mean that if we get any new Medicare insurances then this form has to be updated.

match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",2)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",4)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",277)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",389)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",401)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",405)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",409)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",505)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",577)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",578)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",654)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",655)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",826)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1059)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1158)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1208)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1212)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1218)),"MEDICARE")>0

or match( toupper(find("Insurance","InsCoName","InsuranceCarriersId",1225)),"MEDICARE")>0

Posted : November 2, 2017 2:47 am

joeg1962

(@joeg1962)

Posts: 843

Noble Member

While we often try your first option, part of me always believes that the second option is better. I say this because even if they are still on private insurance, they will most likely eventually get onto Medicare.

This works well if you are trying to see how your Medicare patients are doing for quality metrics. Where this does not help is if you are trying to identify 'new' Medicare patients; perhaps you are trying to do a Welcome to Medicare program and office visit.

All said, unless you obtain patient, dob, ss#, address lists from the Government, unsure how you would know who is truly on Medicare. But, would love to hear better ideas.

~Joe

Posted : November 2, 2017 2:55 am

rwilliams

(@rwilliams)

Posts: 454

Honorable Member

We have come up with a naming convention that we have stuck with. The person who inputs new insurance plans keeps it consistant.

Anything with the word MEDICARE in it is straight medicare. ex:

MEDICARE
MEDICARE SECONDARY
RAILROAD MEDICARE

Medicare replacement plans have the letters MCR in it. ex:

BCBS MCR HMO
BCBS MCR PPO

This way all I have to do is match on either the word MEDICARE or the letters MCR or both.

Posted : November 2, 2017 6:30 am

bhoover

(@bhoover)

Posts: 360

Honorable Member

Topic starter

Your points are well taken. I use either option depending on the need as mentioned above. I tend to go toward option two more often, but usually it depends on if the need is for billing or quality.

Posted : November 2, 2017 7:18 am

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