Why is checking eligibility and verifying patient benefits an important part of Revenue Cycle Management (RCM)?
Checking a patient’s health insurance plan and understanding coverage before seeing a patient is an important step in revenue cycle management. If you skip this step, you risk not getting reimbursed for the services you provide.
Verifying a patient’s benefits involves using online platforms and placing phone calls to payers in order to confirm that the services you are providing to the patient are covered and that there are no limitations to the coverage that you need to know about. For example, the services you provide may be covered yet the patient might have a visit limit and are already maxed out on the visits. Or maybe the patient has a deductible to meet before the insurance company will cover the services. You need to know all of these details before seeing the patient.
By understanding all the ins and outs of a patient’s plan as it relates to the services you provide, you are optimizing your chance at getting fully compensated for the services you provide, both from the patient and from the insurance company. If you fail to spend the time to do a thorough eligibility and benefits check you risk getting denied by the insurance company and failing to be able to collect the total amount from the patient.
In order to make sure that you are able to accurately verify a patient’s benefits, you should always collect a patient’s insurance card. Ask that patient to email you a picture of the front and back of their insurance card in advance of their appointment. If you aren’t able to obtain a copy of their card, at least ask them to provide you with their date of birth, subscriber ID and insurance company name.
Even if you don’t have the time to do a full/comprehensive check at the level that One Body does it, at the very least it is important to make sure that you:
- Check to make sure the insurance plan is active
- Check for secondary insurances
- Confirm if services need prior authorization
- Confirm if the patient has met their deductible and if an amount should be collected from the patient
- See if there are any limitations to the services you provide
- Confirm if the services you provide are covered
The more details you can get the better. If all you have time for is to check the online portals, then you can get some of this information. However, it’s better if you call and ask the payer rep all of these questions as it can serve as evidence in case your claim is denied. Make sure you have the rep clearly state exactly what the benefits are and have him repeat it multiple times to ensure you understand and so the call recording gets all the details very clearly stated.
Another important step is to always review the explanation of benefits(EOB) documents that you get back from the payer after you file the claim. It is important to review it and make sure there are no eligibility related denials. If there are, it is important to review your call notes to see if the rep on the phone gave you the wrong details. If the rep did in fact provide you with incorrect benefits, you are able to appeal the denial with the call reference ID number. Reviewing the EOB also allows you to learn about certain trends or things that are always true for given plans or payers so you can know for next time.
If you need help with verifying you patient benefits, schedule a call with us below!