Radiology Coding Alert

Before you can verify your patient’s insurance, know what information you need to seek from the patient. Be prepared to make necessary confirmations with the payers. It is important to understand how all this matters to your practice and what consequences it can have for you.

Here are the top three questions you should ask yourself and learn what experts have to say about them.

Question 1: What information do you need to seek from the patient for existing insurance?

Experts speak: When the practice is getting information from the patient, be sure to get the patient’s name, birth date, insurance carrier, patient ID number, group plan number, contact information for the insurance company, and the date the patient’s plan is effective. Also check the name of policy holder (if it is different from the patient’s).

Question 2: What questions can you raise to the payer to verify the information you have gathered?

Experts speak: You should follow-up with the payer and ask questions to drill down into the patient’s pertinent data. Confirm if your practice is in-network or out-of-network with the patient’s plan. If the practice is out-of-network, then confirm, are there are any out-of-network benefits? Check, does the patient have a copayment? If so, what it is. Find details of co-insurance if any and check the effective date for the patient’s plan.

Question 3: What are the consequences to your practice if you do not verify the patient’s insurance ahead of time?

Experts speak: If you do not verify the patient’s insurance ahead of time, your practice could suffer loss of revenue and work time. You may additionally damage your relations with the patient and create problems for the payer. All this could potentially result in delay of payments and also nonpayment for your physician’s services.