Ways To Verify Patient Coverage at Your Medical Practice

Insurance Eligibility Verification to Insure High Collection Rates

The bottom line is that successful billing in a medical practice is dependent on successful insurance eligibility verification. In all cases this should occur upon the patient’s first visit and before care has been provided. Ideally, the process is repeated on follow up visits to insure that the policy has not been modified or terminated. Spending just a few minutes verifying insurance could save countless hours and days trying to resolve claim denials. Not having a solid workflow in place can cost a medical practice as much as 30% in lost revenue.

Depending on the size of your operation, you may have a billing team and the budget to have a health insurance verification specialist on your staff. These specialist will gather the necessary information from the patient, complete paperwork and verify the details of the patient’s coverage directly with the insurance company. Even if your medical practice does not have a dedicated specialist on staff, someone will need to take these steps every time a new patient walks in the door.

Take These Steps to Properly Verify Coverage

Fortunately, verifying health insurance eligibility is a straightforward process. However, to do it properly there are a number of steps that should be taken. On a patient’s first visit to your office insure that the following steps are taken.

Gather Patient Information – Request the patient’s photo ID and health insurance card. Make a record of the insurance carrier, the group number and the patient’s insurance ID number. Also make photocopies of the ID and insurance card.

Call the Insurance Company – Most patient insurance cards have the number medical practices should call printed on them. During this call there are a number of important questions that need to be asked. Some of this information may be printed on the insurance card, in which case it should confirmed with the insurance company during the call.

• Policy status
• Payable benefit
• Coverage details
• Referral requirements
• Policy exclusions
• Co-pays
• Deductibles amount and whether it has been met
• Address where claims should be mailed

Verify Secondary Insurance – The patient should be able to tell you if they have secondary health insurance coverage. If they do the steps for verifying it are the same as those above with one extra step. You will need to verify coverage percentages between the two policies or the amount covered by the secondary insurance.

Follow these steps and your medical practices collection rate is sure to improve. Your staff will also be spending much less time trying to secure payment on claim denials. At ProMD we offer a full suite of billing services that can help you raise your collection rate to as high as 98%. Call us today to schedule an appointment with a consultant.

ProMD Medical Billing is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 866-960-9558 or fill out our online form to request a billing assessment.

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