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…..those health benefits! One cannot stress enough the importance of an accurate and complete verification of benefits. It can and will affect your bottom line.

The first step in the billing and collections process is the verification of benefits.  A clean aging report depends upon it.

Surveys have shown that the largest percentage of unpaid claims in many practices was related to verifications.  Either the patient had no coverage, was still in deductible phase, incorrect copays were collected, other coverage was considered primary, or miscellaneous other issues.

Some of those other issues could be:   whether or not the health insurance considers itself primary in the event of an auto accident, limitations on coverage (either a $ maximum or visit limit per year), limited diagnoses covered, pre-existing conditions clause, or no out-of-network coverage.

Oftentimes the staff members who actually perform the task of verifying benefits mistakenly believe that simply going online to the carrier website or gathering information via the automated telephone system is sufficient.

As a medical reimbursement specialist, I have rarely, if ever, found these tools to provide a complete and accurate picture of the patient’s coverage.  They are tools to be utilized in information gathering, but it is imperative in most cases that the staff member verifying coverage and benefits speak to a live customer service representative.  This is especially true when verifying therapy coverage and benefits.

Verifying patient eligibility and benefits takes substantial employee time and effort. But remember that not doing a thorough job of verifying coverage is potentially far more costly, time-consuming and aggravating, as it tends to place a far greater work load on your entire office in the long run. Inadequate verification only creates a delay in payment which, in turn, harms your practice’s cash flow. Take whatever measures you can to prevent such losses!

Be on the lookout for verification tips and trends coming soon!