One of the most important processes you will complete in your time as an insurance-based practice is completing the verification of benefits. What is an “eligibility check” or “verification of benefits”? It is the process of verifying that a patient is going to be covered by insurance, what the patient will owe, and what codes are covered. This process can be long and tiresome due to a long list of reasons, but if you know how to verify benefits then you can get through this process with ease.
There are several online options to verify a patient’s eligibility and benefits. There are several online options that are helpful. Availity (featured below) is one of the most common ways to check eligibility online. However, most insurance companies have their own portal you can use to verify eligibility and benefits.
Availity (www.availity.com): This is one of the most common tools used to verify eligibility and benefits. It is free to create an account and you can add users for free as well. Here are some pros and cons to Availity:
- Robust and easy to use
- Free and you can add unlimited users
- You can get claim status and eligibility information very quickly
- Availity doesn’t have all the insurances that you might take
- Eligibility and benefits are incorrect about 20% of the time
- Deductibles don’t update in real time
Another way to verify eligibility and benefits is to call the insurance company. When you do this, you will want to make sure that you have the number on the back of the insurance card for that patient.
When you get a representative on the phone you will want to ask for Outpatient Mental Health benefits in an office setting. This will tell the representative exactly which benefits to look for.
Additionally, not all representatives are created equal. What that means is that you can get different answers from different representatives. So to make sure you get the best information you will want to get the following information:
- Deductible: Does it apply and if so how much has been met?
- Copay or coinsurance: which one applies for the services you will be rendering?
- Diagnosis: Is the diagnosis a covered diagnosis?
- Out of Pocket (Stop Loss): How much is met?
- Preauthorization: Is 90837, 90834, or 90791 covered with or without authorization?
You can cover the bases if you ask for those variables.
The last way to get eligibility and benefit information is to outsource your benefits. You can do this by training an in-house administrator, hiring a VA, or through a billing company. This will be one way to save time and energy dealing with this part of the process.
If you do outsource you will want to monitor to ensure the accuracy of the information provided or you could end up with credits or not collecting enough from your patients. However, this can be a pretty simple way to get this particular process done in a timely fashion.
Eligibility and benefit checks are important and can be an invaluable service that you offer to your patients. It is important to keep in mind that bumps in accuracy do occur. Keep an open mind and be flexible to change. I always recommend managing your patient’s expectations that eligibility checks can be inaccurate, and I would recommend that you keep their credit card on file in case there is a glitch. Otherwise, this process can save time, money, and improve the patient experience at your practice.
Jeremy grew up in the Pacific Northwest where he discovered his passion for people. He decided to go to college in Chicago to further develop his skills working with people and pursue a degree in counseling. While in Chicago he worked for a group practice as a practice biller and marketing manager. This initiated his desire to pursue learning about the business of Private Practice, particularly medical billing. Jeremy’s website: https://www.practicesol.com/
He now lives in Michigan with his wife of 3 years. They both are pursuing their passion of helping helpers maintain sustainable and compliant billing practices. In his free time, Jeremy loves reading, fishing, biking, hiking, and camping.