Medical
Billing Best
Practice # 1
Eligibility Verification:
What's Covered and What's Not!
The
object of pre-screening a patient's insurance eligibility is to determine
'patient responsibility'. By
discovering upfront what's covered and what's
not
you can practically eliminate non-covered claim denials arising due to
lack of coverage, and your time spent on the
phone calling to verify eligibility will decrease by an order of
magnitude.
If you are
interested in decreasing your account receivables to near zero and
reducing lost revenue due to uncollected debt, then this section dedicated to eligibility verification is for you.
ELIGIBILITY
VERIFICATION
What it is - What it Does!
The
purpose of eligibility verification is to eliminate claim denials, claim
re-submittals and unpaid patient balances in accounts receivable. Let's face
it, it's a heck of a lot easier to simply ask the patient to pay their
portion while they are standing in front of you than it is to go
shagging down the money after they've left. Eligibility
verification allows you to estimate and collect the patient portion
right up front, essentially allowing you to operate a cash practice with account
receivables approaching zero.
There
is a little bit of a shift in the paradigm for the patient but no more than
when Co-Pays were instituted. Patients had to start opening up their
wallets and paying-up right at the window. It's the same with estimating
and collecting the patient portion right up front: No more patient
statements, no more claim denials due to
lack of health coverage and far fewer claim re-submittals.
For
a practice that is not religiously checking patient insurance eligibility
on every new patient and on patients they haven't seen in a while or
whose insurance has changed, eligibility verification, along with other
best practices can constitute a small revolution in your balance sheet
and cash-flow at the end of the month!
