How to Use Real-Time Eligibility Verification Effectively

June 15th, 2010 by Joann Doan

Many of our customers tell us that one of the features in Kareo they like best is the real-time insurance eligibility verification. We’re glad to hear that, and wanted to share some tips for making the most of this feature.

In many practices, the standard process is to check insurance eligibility when the patient arrives for the appointment. This is a good time to check eligibility, but not the best time.

The best practice, according to The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid (Walker, Larch and Woodcock, MGMA, 2004) is to check a patient’s insurance eligibility when they first call for the appointment—while you have them on the phone. That way they can answer any questions regarding policy number, provider, primary insured, etc. And you can ask key questions at that point about co-pays, preauthorization requirements and other issues. The authors suggest that this is easily done: You can tell them, “While I’m looking for an appointment time for you, would you be kind enough to get your insurance card out of your wallet?”

Moving this step as early in the process as possible eliminates the awkwardness that can occur when patients arrive for an appointment and you find there are problems with their eligibility. This way, you won’t have to explain why the doctor can’t see them, or have a suddenly cancelled appointment.

One more important point: It’s best to save the information on the verification in the patient’s account, in case there are any disputes later with the insurance company over when or if the eligibility verification occurred. Kareo saves this automatically for you in the account.

Here’s a quick pre-visit checklist to follow:

1. During the initial phone call, ask the inquirer to get their insurance card ready while you look for an appointment time.

2. Verify the insurance eligibility and ask any questions over the phone before scheduling the appointment.

3. Save the verification information in case of a later dispute (date/time of verification, etc.)

4. As soon as possible after the phone call, send the new patient packet including patient history, HIPAA forms, etc.

5. During the appointment reminder phone call, remind the patient to bring the completed forms and their insurance card.

6. Upon the patient’s arrival, collect the completed forms and copy the insurance card, checking to see that there’s been no change in insurance since the appointment was made.

During this process, remind the patient that you are gathering this information to make sure the process with their insurance company is smooth; you are helping to make sure they receive their full benefits. Of course, your practice will see a benefit as well–you can significantly reduce overhead with practice automation features such as real-time eligibility verification. Electronic verification can eliminate up to 50% of denials on the spot and save your staff from hours on the phone. In fact, the AMA estimates that you save approximately $3,700 per year, $2.95 per verification, by automating your eligibility verification process.

Gathering this information early in the process will slightly increase the length of appointment phone calls, but will reduce time at check-in, and as mentioned, avoid problems at that point. And with medical billing software that includes a real-time insurance verification feature (as Kareo does), you can conduct the insurance verification in seconds.

If you would like to consider a Kareo plan that includes real-time eligibility verification, visit our plan comparison. If you already use the real-time verification, we hope you’ll consider using this tip to make the most of it and improve your practice profitability.

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