The Importance of Checking Patient Eligibility

As patients move between insurance plans at an increasingly high rate, the timely and thorough verification of patient eligibility has become extremely important for hospitals and physician practices.

In addition to verifying whether the patient has active insurance coverage, most insurance plans also provide an overview of plan benefits. Because plan deductibles are now higher than they have ever been, the availability of plan benefits information allows the practice to verify the amount of a patient’s deductible, how much has been met, and whether or not the practice would benefit by collecting coinsurance and deductible amounts prior to rendering medical services.

The recent establishment of healthcare exchanges has added another layer of complexity to patient eligibility. Numerous healthcare exchange plans are affiliated with the large insurance plans – because physicians were not automatically enrolled with the exchanges, it may be unclear when patients present with certain commercial insurance cards whether the patients are actually enrolled with the affiliated exchange.

In addition, insurance sub-plans often create further challenges for patient insurance verification. By way of example, it is a common practice for a patient to present with a Medicaid insurance card that does not specify the specific Medicaid plan with which the patient is effective. By not verifying eligibility, the claim may be billed to the incorrect Medicaid plan, potentially resulting in an untimely filing issue with the correct plan.

The good news is there are now numerous options for checking eligibility in an automated, real-time manner. Precision welcomes the opportunity to set up your office with real-time eligibility verification so that you have comfort in knowing you have proper insurance information on file, thereby reducing the possibility of an unnecessary loss or delay in practice revenue.