How to: Insurance Eligibility Verification
Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan. Maintaining a consistent and accurate verification process is essential to maintaining a healthy revenue cycle. Physicians need to verify each patient’s eligibility and benefits to ensure they will receive payment for services rendered. Insurance should be verified before clinical services are provided and should never be a task the medical billing staff handles on the back end. Follow these steps to reduce the chance your billing team deals with constant eligibility-based denials.
Get a Copy of the Patient’s Insurance Card
Begin the process of collecting insurance eligibility verification information by asking for a copy of new insurance information from the patient. It’s a good idea to ask for a copy of the card even if the patient states that insurance hasn’t changed. An updated image of both sides of the insurance card provides informational backup in case someone mistyped insurance information into the record. Medical billers should double check ID numbers against cards before sending claims.
Contact the Insurance Provider
Contact the insurance company directly to ensure eligibility. Place a phone call using the provider hotline provided by the payer or you can eligibility tools provided by your EMR or billing software. When you can set up electronic eligibility systems for payers, this is the most efficient option. You may be able to import data directly into electronic medical record systems, making the process even faster and avoiding possible data-entry errors.
Insurance Verification Checklist
Ask the right questions during insurance verification. Front office staff should enter information gleaned from the insurance card, phone calls with the insurance company, or electronic eligibility systems. Insurance eligibility verification information in each patient’s electronic medical record for your practice should include:
- Name of insured
- Relationship of the insured to the patient
- Insurance ID and group number
- Insurance name, phone number, and claims address
- Effective date of the policy
- End date for the policy
- Whether coverage is currently active
- Whether the insurance covers the procedure, diagnosis, or services to be provided
- The amount of the patient’s co-pay and deductible
- Whether your practice participates with the plan
- Limitations of the policy, including exclusions or documentation requirements
- Whether a referral, pre-authorization certificate of medical necessity is required for payment
Follow Up with Patient
If there are any questions or concerns, follow up with the patient about insurance information. Using a patient portal to inform patients of eligibility through email or online communication is efficient, but office staff can also phone the patient to let them know about co-pays or other issues. Informing the patient as early as possible about out-of-pocket expenses increases the chances you’ll collect those funds.
Accurate and timely determination of the patient’s eligibility provides a clear view of the patient’s coverage, out-of-network benefits, and accurate insurance information. Though insurance eligibility verification is a crucial process still it consumes a lot of time. E2E Medical Billing Services can complete insurance eligibility verification for you. To know more about our insurance eligibility verification services, call us at 888-552-1290 or write to us at [email protected]