Question

Mr. Donaldson, a patient at New Hope Clinic where you work was in a couple of days ago for a service. Today, Mr. Donaldson, called stating his Medicare Claim was denied because as of two weeks ago he is no longer entitled to Medicare benefits.
a. How would you handle this call?
b. Would it be wrong to adjust Mr. Donaldson s date of service so that Medicare would pay the claim?
c. If so, why? If not, why not?
d. What can happen to the clinic if they adjust the date of service?

Answer 1

a.  express sympathy for his frustration and ask additional questions: do you know why you are no longer entitled to Medicare benefits?  Who notified you that you were no longer eligible?  Have you contact Medicare to resolve this?

b/c.  Yes, it would be wrong and illegal to adjust the dates of service.  Doing so would be fraud.

d.  The clinic could be fined and/or risk losing their Medicare certification.