Minimize Claims Issues with One Simple Step

Most physician practices experience claims challenges, from denials and rejections to payment inaccuracies.  As frustrating (and costly) as those issues are, they are almost avoidable with one simple step:  verifying patient insurance eligibility.

For patients covered by Medicare, it may seem like a waste of time to verify insurance after the initial visit.  However, how can you be sure the patient did not knowingly or erroneously enroll in a Medicare HMO with which you are not contracted?  You would continue to see the patient and find out only when your claims are rejected that you, basically, volunteered your services with this patient.

For patients covered by Medicaid, eligibility can vary, so it’s crucial to verify that the patient is still enrolled in the Medicaid system for every visit.

Finally, for patients covered under third party insurance, the potential issues are numerous.  Coverage can end or change on a monthly basis.  We know that patients lose their jobs (and insurance coverage) and employers can change plans at any time. With the trend toward insurance premium increases, more employers are shopping around for less expensive coverage which can mean less benefits or more cost-sharing for your patients. Failure to verify that the patient is still eligible for your services, that the insurance is still active and the co-payment or co-insurance levels will certainly lower the chances that your practice will lose revenue.

We recommend that you create a short form to capture the information and then file it in each chart.  An alternative is to note the verification on the daily schedule and have the employee sign off that the verification has been done.  The manager should keep the proof of verification until all claims are paid. If there is any problem, you can ask the employee to explain how benefits were verified.

This entry was posted in Coding & Billing, Practice Management and tagged , , , , , , , , . Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *