Recently, insurance policies have been changing, putting more and more of the financial burden on the patient, in the form of copays and high-deductible plans. Because of this change and this increase in financial obligations that patients are faced with, it’s becoming more important for medical practices to verify each patient’s insurance eligibility—before the office visit, if possible.

Verifying patient eligibility before a patient sees a physician has a number of benefits, and overall will save your practice both time and money.

When a patient comes to your medical practice, whether they are a new or returning patient, they should bring their insurance identification card with them. The member of your staff at the front desk responsible for checking in patients should then proceed to check with the insurance carrier (whether Medicare or a private carrier) to verify that the patient’s information is correct and up to date.

Ways to Verify Patient Eligibility

There are a number of ways your staff can run this verification process. For example, a number of private insurance carriers have a database on their website where your staff can check for the patient’s information. If this isn’t an option, your staff member may have to call a representative from the carrier to verify the patient information.

However, if your medical practice is looking to speed up this verification process and reduce the number of errors sometimes seen from a manual process, there are also electronic patient eligibility verification options on the market that can automate this process for your practice.

Reasons to Verify Patient Eligibility

There are a number of reasons to verify patient eligibility up front, and these reasons vary depending on what type of practice you run. A primary care provider may only be interested in whether or not the patient’s insurance is up-to-date, while a specialist would be interested to know if the patient’s copay at a specialist physician is different from the copay for primary care.

Regardless, practically every physician will be interested and vested in knowing on whether or not they are in-network or out-of-network. That is, whether or not their practice is covered by the patient’s insurance, which will help you determine how much you need to collect from your patient at the time of visit.

Benefits of Verifying Patient Eligibility

First and foremost, verifying patient eligibility before the patient is seen by the doctor will reduce the number of denials you see from insurance companies, as you have verified that your patient is covered and that you will be reimbursed. This, in turn, will result in a more regular cash flow for your practice, as you’ll be receiving reimbursements instead of denials.

There are a number of other benefits you’ll see from this up-front eligibility verification. For example, your staff will see an improvement in their productivity and a reduction in the time spent invoicing and billing patients after the visit, as the “hard work” is done up-front.

 

It’s important to keep in mind that your patients’ insurance plans will continue to change, even if they haven’t changed just yet. For this reason, it’s both smart and forward-thinking to continually verify patient eligibility before seeing a physician, just in case their plan (or copay) changes between visits.

Additionally, for new patients who schedule and provide insurance information ahead of time, it’s also a good idea to verify their insurance before they even come into your office. Just as with your returning patients, this will ensure that you collect the right amount at the time of visit.

 

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