Eligibility Done Right
Commercial Insurances:
Have you ever been frustrated to learn that an insurance isn’t going to pay your therapy claim? “But why?” we ask “I called and they told me Therapy was a covered benefit”. And then that snarky person on the other end of the line says something like “the patient’s diagnosis is excluded for coverage.” ARE YOU KIDDING ME?! That would have been nice to know when I called last time.
Have you ever thought that someone should make a list of all the right questions to ask? That way your intake coordinator can follow a simple formula to ensure that your client’s insurance plans will actually pay for claims. You’re in luck!
Eligibility for commercial insurances is not as simple as checking a website for coverage. There are so many traps to watch out for and the best practice is to call each insurance to verify benefits over the phone. These departments are very quick to try to get providers off the phone so it’s important to have a checklist ready to pepper them with questions. And always be sure to get a confirmation number to keep on hand for backup once you’re done with the call.
If your front office is having trouble with Commercial Insurance eligibility, have them use the “Eligibility Cheat Sheet” on our resource page. It’s an easy-to-follow flowchart that walks you through a very specific set of questions to achieve the desired results=insurances that will pay.
Medicaid and Medicaid Payers:
Florida Medicaid not only requires providers to check eligibility for changes at the beginning of the month but also on each date of service. You did not read that wrong. If a patient shows up for therapy 3 days a week, Medicaid assumes that you checked their eligibility on each date of service.
And, contrary to popular belief, Medicaid changes don’t just happen at the beginning of the month. And…AND…name changes, don’t get me started on patients who change their name. I had an office almost lose $2000 because a patient changed his name. Why do I say they “almost” lost it? Because they had proof of eligibility on every single date of service under the patient’s old name. And we used that proof to appeal the recoupment request from his insurance. PHEW!
It’s easy to get overwhelmed and I’m not recommending that your office staff checks every patient every day for eligibility. However, there is an affordable and easy way to check Medicaid eligibility every single day and avoid those kinds of costly recoupments. I can say this from a completely unbiased point of view that if you are a Medicaid provider with a large patient population, you need to make the small investment in a technology called Eligipro.
Eligipro checks eligibility on every single Medicaid patient every day and sends you an email alert with any changes from the day before. So if the patient loses coverage, changes coverage, picks up coverage, or even changes their name, you’ll know asap. Full disclosure, I don’t have any financial interest in Eligipro but I know (and use) a good product when I see one.
To learn more, go to https://eligipro.com/ and tell them I sent you!
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