Eligibility Verification: Subscriber Not Found
Welcome to Tuesday Tips with MODPractice!
This week’s tip: VERIFY VERIFY VERIFY!
Everyone always wants to know the secret to reducing denials and aging claims. The problems often start at the beginning with insurance verification and eligibility! A full insurance verification and breakdown of benefits should be completed on every new patient. Most offices are good about this part BUT if they information is not entered directly into your practice management system with the SAME INFORMATION THE INSURANCE COMPANY HAS ON FILE, you’re going to have an issue with some payers.
What does this mean? Are you verifying that a dependent child has the same last name as the subscriber? Are you verifying that the patient’s formal name or hyphenated name is on file with the insurance rather than a nickname they might have given or a married surname but the coverage is still under their maiden name? Are you repeating all information back such as date of birth to ensure it’s correct?
Imaging the conversation going something like this:
Front Desk: “Thank you for calling Rockstar Dental Arts. This is Jen. How may I help you?”
Patient: “I found your office listed on my insurance website and I would like to schedule an appointment.”
FD: “I’m so happy to hear that. We have a new patient appointment available on Tuesday at 4pm or Thursday at 10am. Which do you prefer?” (patient picks a time or FD finds a different time that works)
FD: “I need some basic information to create your chart…..name, address, phone, dob, insurance company, member id, employer/group….”
FD: “Thank you, let me just confirm everything:
“Your DOB is 12/31/1999?…(yes)…The name on file with your insurance company is Danny….(oh, no it’s Daniel).. and so on?”
Even with the intentions of having the best conversation, your patients still may not give you the correct information. If you’re utilizing online check-in and/or the patient is uploading or securely emailing their insurance card, you’ll most likely be able to collect the rest of the information. If not, you may need to give the patient a call but ultimately, verifying that all of the information in the practice management system (and therefore the claim) matches the information that the insurance company has on file is going to ensure your claims are paid in 2 weeks instead of 2-3 months!
Interested in learning more about Revenue Cycle Management for your practice? Contact us today!