Medicare Front-End Screening — VA Decision Tree
Virtual Assistant · Front-End Screening

Medicare Patient Screening

Stop and identify the type of Medicare before verifying or scheduling. Answer each prompt with the caller's cards in hand — never the patient's word alone.

RULE #1
Medicare patient = STOP and identify the type first.

Get photos of all insurance cards, front and back. The card is the source of truth, not the caller.

Original Medicare + diabetes/CKDMEDICARE Verify order + remaining MNT hours.
Original Medicare, no diabetes/CKDSELF-PAY Non-covered → ABN / financial acknowledgment.
Medicare Advantage (Part C)HOLD Do NOT auto self-pay. Verify exact MA plan + nutrition benefit.
Medigap / Supplement (G, N, F, AARP)FOLLOWS OM Not separate nutrition coverage; follows Original Medicare.
Other secondary insuranceVERIFY COB Identify what it actually is, then check coordination of benefits.
Not a guarantee of payment. Benefits must be individually verified for every patient — there is no universal MNT coverage even within one insurer. Original Medicare MNT covers diabetes and CKD stage 3–5 (and ≤36 months post-renal transplant) only; prediabetes alone does not qualify. Built for internal front-end screening.