Last Modified: 6/26/2018 Location: FL, PR, USVI Business: Part A, Part B
What Can SPOT Do For You – Eligibility and benefits information
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Use eligibility and benefits to prevent denied claims
Snowbirds, splitting their year between Florida and places north, can complicate matters for providers billing Medicare for services provided to these beneficiaries. When they receive preventative services from their physicians in their summer hometowns, and then visit Florida doctors during winter months, some beneficiaries may not be eligible for services and medical tests typically covered by Medicare.
“With our snowbirds, we have to stay on top of their eligibility status,” said one Medicare billing manager. “Many beneficiaries aren’t aware they enrolled in a Medicare plan different from the traditional plan. They know they have Medicare and that’s it. Having fast access to Medicare eligibility and secondary payer information helps us file clean, accurate claims and get reimbursed sooner.”
First Coast Service Options Inc. (First Coast) offers such access through SPOT (Secure Provider Online Tool). With SPOT, providers may access Part A and Part B eligibility status as well as benefit eligibility for preventive services, deductibles, therapy caps, inpatient, hospice and home health, Medicare secondary payer (MSP), and plan coverage data categories. SPOT also offers the opportunity for providers to search for a Medicare Beneficiary Identifier (MBI) through the MBI lookup.
SPOT eligibility and benefits tutorial
This tutorial on SPOT's eligibility and benefits information will show you how to use this tool to streamline your billing operations and reduce denied claims.
Viewing preventive service information before the patient arrives
Preventive services data includes both professional and technical services along with the next eligible dates or previous date the service was provided. SPOT eligibility reports show preventive services that are gender-specific to each beneficiary. Preventive services data viewable in SPOT includes:
• Abdominal aortic aneurysm ultrasound screening
• Annual depression screening
• Annual wellness visit
• Bone density measurements
• Cardiovascular disease screening
• Colorectal cancer screening
• Diabetes screening tests
• Fecal occult blood test
• Glaucoma screening
• High intensity behavioral counseling
• Initial preventive physical examination
• Intensive behavioral therapy for cardiovascular disease
• Intensive behavioral therapy for obesity
• Mammography screening
• Pap test screening
• Pelvic screening exam
• Prostate cancer screening
• Smoking cessation
Using SPOT to access preventive services information for your patient may significantly reduce your number of claim denials by checking the preventive services information before performing a test and providing the service.
“Once we had access to SPOT, I went in and pulled the first two months of claims data through the provider data summary (PDS) report,” said Tracie Jones, a Medicare billing manager for Simon-Med facilities in Central Florida.
“Most, if not all, of the denial codes we had were related to routine ultrasound tests and preventative exams. One procedure with an extraordinary high number of denials was DXA, a bone density test for measuring bone mineral density that is only covered by Medicare once every two years,” Jones explained. “We worked with our scheduling department to make sure we were only performing the DXA test according to Medicare guidelines.”
With SPOT, Medicare providers have several tools available to diagnose, correct, and prevent denied claims. SPOT gives you the ability to view claims status and patient eligibility information online, conduct detailed data analysis at the claim and provider levels, reopen claims to make clerical corrections on multiple lines, and submit redeterminations and additional development responses (ADRs). First Coast offers SPOT to providers at no charge.
How to get your SPOT account
First Coast provides a step-by-step guide to assist you in establishing your SPOT account.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.