|I know how frustrating it is to be on the phone, being on hold with the insurance
company just to verify patients benefits and eligibility. I had billers I have worked
with in the past that all she does in that practice is to verify patients eligibility.
But trust me, as long as you have a smooth system in your practice, it is not too
bad --- if not, it is very important that you have to check your patients eligibility for
Here are the simple tips I can share with you:
1. Get all the patient's information over the phone, set up an appointment for them.
But remind them that you will verify their insurance coverage (it's just an office
protocol). Tell them, you will get back with them if there is a problem.
2. Verify your patient's eligibility the soonest you can.
3. If you don't have enough information (such as the insurance ID is not right), then
try the social security. Usually, insurance companies would give you information if
you have the social security number. The tricky part though, if the patient is not the
policy holder--- then the social security will not be of help. That's why, it is also very
important that you get the policy holder's information (besides, the person really
becomes the guarantor of your patient!).
4. Patients coming from a primary care physician or other referrals can also be a
source of insurance coverage information for the patient.
Now, with patients who are coming from a Workmans Compensation Case or an
Auto Accident Case. You will need the following information to verify medical
1. Patient's Name
2. Date of Birth
3. Claim Number
4. Policy Number
5. Date of Accident
6. Adjustor's Name & Contact Information (Phone/Extension, Fax, and Email)
7. Case Manager's Contact Information (if there is an assigned Case Manager)
The Questions you will ask from the adjustor:
1. Patients eligibility for Medical Coverage (being specific is very helpful too! --
like ask if the patient has Pain Management Coverage , because it is possible
the patient is also being seen by another pain management provider);
3. Any deductible that the patient has not met
4. TIP: Initial Evaluation/First Visit usually do not require prior authorization.
Obviously, how can you come up with a treatment plan without the initial
Check your patients eligibility before you confirm their appointment the next day!
Good business means growth!