What action should a specialist take to determine 3rd party payer responsibilities for a patient with Medicare coverage?

To determine third-party payer responsibilities for a patient with Medicare coverage, establishing coordination of benefits is essential. This process allows healthcare providers to identify the order in which multiple insurers pay for a patient's medical expenses, ensuring that the correct amounts are billed and that the patient is not overcharged.

When Medicare is involved, it is crucial to ascertain whether there is another primary insurance that must be billed first. Coordination of benefits is the systematic approach to coordinate payments from multiple insurers, completing the billing cycle efficiently. This is vital because if there is another active policy, it typically pays first, while Medicare may cover remaining eligible costs.

If this step is overlooked, it could result in billing errors, delayed payments, and potential financial liability for the patient. Establishing this coordination upfront helps to clarify the roles of each payer, ensuring compliance with regulations and optimized revenue cycle management.