Verify patient's eligibility for Medicare benefits
Check for the existing or previous Medicare coverage details
Compile details of healthcare services provided to the patient
Ensure accuracy and competeness of the medical records and claims documentation
Confirm coding compliance with Medicare regulatory requirements
Review calculation of the Medicare reimbursement amounts
Approval: Medicare Reimbursement Calculation
Address potential overpayment or underpayment issues
Evaluate provider participation in Medicare quality reporting initiatives
Check compliance with HIPAA privacy and security rules regarding Medicare patients
Identify any potentially fraudulent activities or patterns
Submit claims to Medicare for reimbursement
Track submitted claims and monitor reimbursement statuses
Review and respond to any audits or inquiries from Medicare regulators
Approval: Responses to Medicare Regulators
Implement corrective actions if necessary based on audit findings
Maintain proper documentation of all Medicare compliance activities
Conduct annual reviews to ensure ongoing compliance with Medicare requirements
Approval: Annual Compliance Review
Provide mandatory compliance training to staff involved in Medicare billing and claims
