Should I Verify Patient Eligibility?

When Should I Verify Patient Eligibility?

Even just a few years ago, verifying patient eligibility once a year was good enough, as most patients stuck with their insurance providers for the long haul. However, the market is changing, and more and more patients are switching over to higher deductible plans and plans based on cost sharing.

Today, a patient’s insurance information can change over night—which is why it’s increasingly important to regularly verify your patients’ eligibility. But when, exactly, should you verify patient eligibility?

This is a very common question to ask—and a very important one, as well. However, unlike in a few years ago, there are now a number of occasions when you should verify eligibility, as we’ll discuss below.

When Appointments Are Scheduled

Considering that eligibility issues are one of the leading reasons why claims are delayed, denied, or rejected, it’s important to start your eligibility verification process as soon as appointments are scheduled.

This will give you plenty of time to look into any issues you might find. For example, if you find an error this early on, you have time to contact the patient before they come into the office, saving you both the hassle. Additionally, by verifying their eligibility, you can also estimate what their payment responsibility will be at the time of service, and pass this along—again, saving you the hassle of surprising them with a copay when they check in.

Before Actual Appointments

Additionally, it’s also smart to verify the patient’s eligibility again 2-3 days before the appointment, especially if you schedule appointments far in advance. This is smart as the patient’s remaining deductible levels can change in a matter of days.

At Check-In

If you didn’t verify patient eligibility when the appointment was schedule, or a couple days before the actual appointment, check-in is your last option to do so before your patient receives their service. At this point, it’s also recommended that you have your patient payment policies outlined and accessible for patients, which will make it easier for your front desk staff to educate patients and collect their payments.

After the Appointment, If Needed

Another considerable effect early and active patient eligibility verification can have on your practice is the reduction in A/R days outstanding, as the cleaner claims can result in fewer denials. Additionally, in the event of denials, verification software can also aid in your appeal letters. If a claim is denied, take the time to re-verify to help prove that the patient was eligible at the time of service.

Every Month or So

And lastly, it’s also smart to run a batch eligibility inquiry of all your patients every month or so, if you use verification software capable of running this sort of inquiry. As mentioned, it’s no longer good enough to verify eligibility once a year—in fact, most recommend running a bulk verification every month or so, in order to catch any changes in your patients insurance coverage or deductible levels.

Of course, verifying eligibility at each of these occasions can be overwhelming, especially if you don’t have the software to support automated inquiries. By leveraging patient eligibility verification software, however, you can keep a closer watch on your patients’ plans, as well as on your revenue cycle efficiency.


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