What Is Patient Eligibility: A Short Guide

patient eligibility

Owning a business is a challenging venture. Running, maintaining, and growing a successful enterprise would not be possible without the financial fuel to sustain it. As a result, getting paid promptly is critical for any business providing goods or services.

One industry that requires extra care when it comes to receiving compensation is the medical field. While most companies can accept payment through someone’s credit card, high healthcare costs often mean doctors receive payment from insurance companies for their work.

However, insurance companies must verify patient eligibility before reimbursing doctors and private practices. These verification processes can be cumbersome, and rejected claims can cost private practices thousands of dollars.

Revenue cycle management companies like PracticeForces have years of experience providing these services. As a cardiology medical billing service company, our agents will work to ensure your patient eligibility verification process is smooth and results in your deserved revenue.

What Is Patient Eligibility?

Patient eligibility is the process by which practices confirm benefits information from their patient’s insurance companies like copayments, coverage, deductibles, and coinsurance. Without going through the process of patient eligibility, doctors don’t receive compensation for their services.

While this practice might seem like an annoyance, allowing billing through insurance is a primary way of ensuring that healthcare is affordable for most people. Unfortunately, many private practices are inefficient in these processes or make mistakes that result in rejected claims and revenues.

Despite the pitfalls of this system, understanding how to avoid issues with patient eligibility allows practices to retain their earnings and get paid what they deserve.

How To Avoid Issues with Patient Eligibility

With these few simple steps, your private practice can avoid patient eligibility issues, saving you money and time.

Understand Your Patient’s Coverage

The most critical aspect of strengthening your patient eligibility process is understanding your patient’s insurance plans when they first enter your practice. Make sure to know whether they have multiple plans, rely on Medicaid, use Medicare, or have an inactive account. In addition, check what services their plan covers and see whether they might need prior authorization for eligibility in your practice.

Collect Ample Demographic Information

When intaking patients, collect as much specific demographic information as possible. Demographics significantly impact Meaningful Use reporting, which will help you justify using insurance to provide your services. Claims submitted without sufficient demographic context and Meaningful Use reporting will see rejection more quickly than others.

Create a Standard Operating Practice

It’s critical to have a standard operating practice around patient eligibility. Devise a plan for your private practice, such as collecting information at the time of service or requiring patients to upload insurance information before their appointment. Maintaining a consistent approach to patient eligibility helps to eliminate issues.

Hire a Revenue Cycle Management Company like PracticeForces

One of the best ways to mitigate issues with patient eligibility is by hiring a revenue cycle management company like PracticeForces. Learn more about strategies to secure revenue during the pandemic and patient eligibility by calling (727) 499-0351 or visiting our website to set up a consultation.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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