When does your practice verify patient eligibility, co-pays and deductibles? If your answer is anything other than “in advance,” you are wasting valuable time and money. Why is verifying patient eligibility in advance such a necessity for today’s practice?

The Patient Verification Process

When a patient visits, your office needs to know what their insurance company requires for co-pays and deductibles in addition to the patient’s eligibility for services. This can be done by using the patient’s insurance card to verify information with the carrier. While primary care doctors typically only worry about whether or not the insurance is valid and what the patient’s financial responsibility is, specialists are often under different sets of rules. Waiting to verify a referral or specialist eligibility until a patient shows up for their appointment is never a good idea.

In addition to the above, your practice also needs to know whether you are considered in network or out of network. Are you seeing Medicare patients? Understanding the benefits that your patient has is critical, because many patients confuse Medicare Managed Care Plans with other Medicare offerings.

Checking in Advance is Critical

If you aren’t already convinced after reading the above, consider how much time it takes you to verify that information for each patient. Some insurance companies have excellent customer service, while others take at least 30 minutes to reach on the phone. If a patient comes in without a referral, your receptionist will spend valuable time trying to track down the referral instead of assisting other patients.

Verifying New Patients

Every time a new patient calls to schedule an appointment, take the time to discuss their insurance coverage with them and forward any necessary paperwork. Investing a small amount of time before the initial appointment can save money and time the day of. To determine a patient’s insurance eligibility, you should always collect the following:

• Name and date of birth
• Name of the primary insured
• Social security number of the primary insured
• Carrier
• ID number and group number
• Contact information for the insurance company (should be listed on the insurance card)

Next, take the time to call the insurance company and confirm:

• That the patient is currently covered by the insurance
• The coverage effective dates
• Whether your practice is in network or out of network
• If the services that the patient will be receiving are covered
• If a referral or pre-authorization is needed

Verifying Current Patients

Every time you see a current patient, verify that nothing has changed with their insurance since their last visit. Again, a little bit of time invested before they come to your office will ensure prompt payment and correct eligibility.

Bring Your Verification Into the Modern World

For a faster way of verifying patient eligibility, use a web-based system like IntakeQ. Your practice can load intake forms directly to a secure website and get notified every time a patient completes them. This allows you to verify eligibility in advance and without the hassle.

Vetters Practice Management Consulting

Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.