How to Properly Do Benefits Verification

How to Properly Do Benefits VerificationIf you are in the medical billing and coding field, you may be asking, “When do I verify a person’s benefits?” This is a good question to ask if you are just starting out in the medical billing profession.  Before giving any services to the patient, you should always verify that the patient is insured and what they qualify for exactly.  In order to verify the benefits, you can simply call the insurer and ask them if the patient is actually covered.  If the client is not covered by medical insurance, then the patient should be asked to pay for services before they are given by the doctor.  Unfortunately, not every patient will have medical insurance or insurance that is good enough to pay for treatment.

As each day passes, your patient should be able to say what works and what does not work.  When it comes to medical billing and coding, you should already have some idea of what insurance companies your doctor is connected with.  If the patient has changed employers, they may not be fully aware that their insurance has changed as well.  You may find that a person used to have insurance that could be used at your facility and now it cannot be used. This is something that needs to be addressed immediately and for several good reasons. It is important to have co-payments always checked as well. Usually there is a co-pay amount marked on the insured person’s card. However, you should be able to check into the database to see how much the patients co-pay is.  There is usually a separate co-pay for a regular M.D. and for a specialist.

Benefits verification can also be done by an outsourced billing company.  Many physicians today are outsourcing their billing because it is much easier and cheaper than doing it in house. If you are a billing company, you can easily earn lots of money and good reputation by helping physicians and hospitals to better their billing. In some way, shape or form, billing becomes acceptable when the doctor is getting good revenues coming into the practice. There is always something that the doctor can learn to understand from their billing practices.  Patients are often unaware of how health insurance and billing works.  In the patients mind, they just want to get help.

Many patients will try to argue with you saying that their insurance does cover the service and yet the insurance company is saying that it does not.  It is always wise to use your medical insurance properly. In today’s age, you cannot play around with health insurance.  Many people are worried that their insurance will not be accepted and therefore, it is up to the benefits coder to tell them what they qualify for. If you tell the patient incorrect information, there is a good chance that the doctor can be held liable to pay the bill.  Doctors need to have their own internal auditing to make sure that this does not happen. In this way, you are ensuring success.




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