Podiatry Coding & Billing Alert

Question: Do I have any options for filing claims on patients who say they have new coverage but haven’t gotten an insurance identification number or card yet?

North Carolina Subscriber

Answer: It’s always a best practice to have someone in your office confirm coverage and eligibility when scheduling appointments, but because most employers hold open enrollment in December it’s particularly useful in January, when you’ll see the most insurance changes. Take note that benefit, deductible, and copay changes might happen in addition to payer changes.

It’s important that your office verifies the date of eligibility with the payer. A patient with a new job and new insurance coverage may be in your office for a visit today, but his insurance isn’t effective for two months because many employers don’t make health insurance coverage immediately available to new hires.

Finding out about insurance changes before the appointment gives you time to check if you are a participating provider with the payer and verify coverage. If the patient doesn’t yet have an identification number with her new insurance company, ask for the name of the insurer and the policy number from the patient, or from the patient’s employer. Then, call the insurer and verify the coverage and the date of eligibility, and get the appropriate information to identify the patient on your claim.

Although verifying coverage in advance is preferable, many practices have patients confirm their insurance coverage and note any changes when they check in for their appointments. If you are unable to verify the insurance coverage, or you find that the patient is not eligible for coverage on the day of the visit, inform the patient of the problem and ask if he wants to reschedule the appointment.