It is more essential that every physician practice verify the insurance eligibility and benefits of patients before services are provided. The success or failure of each patient claim begins and ends in the front office. Why? Patient insurance eligibility verification is the first and perhaps most critical step in the billing process.
Training staff to complete this task can help boost revenue at time of service and save time on the back end. That means your front office has to be on the ball to obtain and accurately record all eligibility information.
The front desk staff is responsible for checking in patients and should make it a priority to check the patient’s insurance carrier to ensure the information on the card is up to date and correct for that date of service.
Your staff is responsible for determining each patient’s insurance eligibility, including:
- Coinsurance & Copay
- Benefits Cap
- Deductible
- Whether the payer requires specialized forms or additional documentation
- Where to send the claim.
Insurance Re verification:
Your front office staff also should re-verify the patient insurance when appropriate. For example, If your patient gets a new job, he or she will have new benefits and that means you’ve got to complete a new eligibility check. But benefit details like Deductibles, Copays, Coinsurances, and type of coverage can change at the beginning of the year and/or month. So, if you haven’t seen the patient for a while, or if you recently flipped a page on the wall calendar, then it’s time to re-verify insurance.
Insurance Verification Policy Period:
By checking benefits within a short window of time before the patient’s appointment, you’ll help ensure patients are clued in to their financial obligation so collecting payment is easier. Consider implementing a 72-hour verification period policy for your front office and it saves you from no-shows and day of cancellations due to high deductibles.
Your office staff should confirm whether the patient’s plan will consider the specialist an in network or out of network provider. This is vital, because it will affect who is responsible for the main part of the bill. The primary advantage of determining that the physician is an in network provider is to allow the physician to receive a negotiated or discounted rate for the services, and the patient’s insurance generally picks up a larger portion of the bill.
For Example: If the physician is an out of network provider, then the patient will need to pay their portion of the bill at the time of the visit.
Auto Insurance Eligibility Verification:
If you work with an auto accident patients, don’t forget to verify eligibility with their auto insurance companies, too. You can even include a separate section for it on your patient intake forms, like Physical Therapy and Sports Medicine Center.
Just as you would with a regular health insurance company, verify that the patient is covered and confirm that the patient is approved for physical therapy visits. You should obtain proof of authorisation and provide the auto insurance company with any necessary authorisation forms before providing any kind of service.
“Insurance Eligibility verification may seem like a run of the mill task, but without performing this step and collecting all the pertinent information, your claim is dead in the water. With a capable and confident front office staff, you can greatly reduce your clinic’s number of underpaid claims, denied claims, and delinquent accounts and dramatically improve your bottom line”.