{"id":7657,"date":"2022-01-19T17:39:21","date_gmt":"2022-01-19T12:09:21","guid":{"rendered":"https:\/\/www.medisysdata.com\/blog\/?p=7657"},"modified":"2022-01-25T18:02:04","modified_gmt":"2022-01-25T12:32:04","slug":"checking-patient-eligibility-and-benefits","status":"publish","type":"post","link":"https:\/\/www.medisysdata.com\/blog\/checking-patient-eligibility-and-benefits\/","title":{"rendered":"Checking Patient Eligibility and Benefits"},"content":{"rendered":"

Patient eligibility and benefits verification is the process by which medical practices confirm insurance coverage for planned care. This insurance coverage report will include information such as coverage, co-payments, deductibles, and coinsurance with a patient\u2019s insurance company. Patient eligibility and benefits verification is an important process of Revenue Cycle Management (RCM), which comprises the steps practices must take to keep track of revenue and ensure they get paid. By verifying eligibility, practices determine patient insurance coverage prior to appointment and can cross-check any updates in demographic information. Proper eligibility and benefits verification will ensure a complete insurance coverage report prior to appointment, resulting in lesser denials and increased patient collections.<\/p>\n

Checking Patient Eligibility and Benefits<\/h2>\n

Practices mostly use two different methods to verify eligibility i.e., electronic real-time eligibility checks and manual checking. You can use electronic real-time eligibility to run checks at least 48 hours before the patient\u2019s appointment. Electronic real time eligibility may not be suitable option for small practices with lesser visits. Small practices manually check patient eligibility and benefits. Practices call the insurance rep and ensure insurance coverage details like patient\u2019s insurance status and benefits; patient\u2019s benefit plan; unpaid deductibles; co-payment; and dollar amount against tentative procedure codes. Practices also ensure patient demographics is updated along with information like primary care physician (PCP) and coordination of benefits (COB).<\/p>\n

In case of a manual eligibility check, simply call the insurance company\u2019s contact number listed on the back of the patient\u2019s insurance card or log into the payer\u2019s web portal. When you call insurance, information required will be subscriber name; patient name; patient\u2019s relationship to the subscriber; patient date of birth (DOB); patient gender; patient member number; group name and number; and plan type coverage date. The insurance rep will ask and cross-check any of the patient\u2019s demographic details and practice details to ensure that you are an authorized, person. Practices should proactively check eligibility. The most effective time is before the patient is seen by the physician, ideally 48 hours before the visit.<\/p>\n

Best Practices for Eligibility and Benefits<\/h2>\n

To decrease denials and potential delays in revenue, follow these best practices prior to the visit:<\/p>\n