Optimizing The Revenue Cycle 3 of 12: Insurance Eligibility

Posted by Crystal L. Miner, MBA-HSA, FACMPE on Dec 28, 2018 7:49:00 AM

With the increase in recent years of patient deductibles and copays, the burden of patient collection has shifted to the front end of the visit. The Front Desk Team is now responsible to know what they need to collect from patients at the time of the visit. It was not that long ago when clinics and patients expected insurances to cover most services performed. Thus, little was collected at the time of the visit and most was left for the Billing Team to collect from insurance companies. It was also expected that patients know which specialty services their insurances did not cover. I remember having and seeing signs posted in waiting rooms specifically telling patients “There are over 1,000 different insurance plans, we cannot know the specifics of yours. Please call your insurance carrier and be aware of your coverage and copays.” This is the case no longer. 


High performers in healthcare have found that the best method for enhancing their patient collections is to perform insurance eligibility checks and gather copay/coinsurance/deductible information before the patient arrives for their visit. A recent Navicure article notes that ‘one of the most important components in today’s revenue cycle is patient eligibility checks and verification.’ However, to know that a patient is eligible for their insurance is only part of the battle. Clinics must then be the ones to inform the patients of their copays, coinsurance, and deductibles. Allowing a patient to arrive for the appointment uninformed can lead to either negative experience for the patient or a negative financial experience for the clinic.

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Topics: revenue cycle management, Medical Practice Improvement, Insurance Eligibility