Practice Management Alert

Do your investigative homework: Sniff out ineligible patients and other insurance pariahs before they become patients in your practice.

You may think there's not enough time to verify a patient's insurance eligibility prior to service. The office receptionist is already too busy juggling phone calls, scheduling appointments, and handling irritated patients lined up in the waiting room. That leaves little time for her to verify the patient's insurance before seeing the doctor.

However, if you don't have clean eligibility on a patient, "You're never going to get paid," said Victoria Jackson, administrator and chief executive officer of Southern Orange County Pediatric Associates in a recent The Coding Institute teleconference. "I know it's a task no one really likes to do," but eligibility verification is "extremely important" for insurance collections, she says.

By checking a patient's insurance eligibility and obtaining a copy of her insurance card, you prevent not only claim denials but also payment delays that arise when patient insurance information doesn't match up with the carrier's.

Eligibility verification means running a check on the patient's insurance information: that a patient belongs to the group you're billing and that her group identification and member ID are correct. You should obtain this information prior to the patient's initial visit, Jackson says.

A patient's insurance and ID number may be all that you need. If you have the staff, call the patient to get that information before her visit, Jackson says, and then verify it by calling carriers. Most carriers store information online, so if you have Internet access, a computer search will verify the patient's insurance. You can designate a specific employee to do this research. Regardless of whether you obtain this information before the patient comes in, make sure you copy her insurance card before you provide services. The card both verifies the insurance information and provides important details, such as the insurance plan's geographic specificity. Let the Patient Help You Get the patient to verify her own information, Jackson says. Give the patient a copy of the encounter form or the superbill with insurance information printed on it, along with the patient's name and address, and ask that the patient initial the starred information, she says. Double-check insurance information every time a patient comes into the office so you can rest assured that claims will not come back denied, Jackson says. Skipping these periodic checks can cost you.

Suppose, for example, that you inadvertently send out old insurance information on a claim. The insurance company processes the claim and sends it back informing you that the patient was no longer covered at the time of service. Then you must transfer the payment to patient responsibility, or you have to [...]