Explore this issueThe Rheumatologist: Vol 11 – No 5 – May 2017
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- B—Most employer insurance plans change on Jan. 1. Because of this, it is a best practice for medical office staff to ask if there is any change to a patient’s medical coverage. Even if the patient indicates there are no changes in coverage, staff should still request to review their insurance card. Keep in mind that even if there are no changes in coverage, the patient may have received a new insurance identification card.
- C—Contact the insurance carrier to determine benefit guidelines (e.g., prior authorization request, benefit level). When a patient is beginning a new procedure, a call to the insurance company should be made for verification of benefits and prior authorization requirements. This will prevent delay in reimbursement for the service.
- False—It is highly recommended that insurance eligibility be verified prior to the delivery of all treatments. A patient’s insurance coverage may change due to drug formulary changes or policies from the insurance administrator. If eligibility is not verified with the insurance carrier, there is a risk of not receiving reimbursement from the carrier or the patient.
- Yes—Each carrier may have different medical policies for a procedure; therefore, different requirements may apply.
- False—A verification of benefits means the patient is eligible for coverage. This process ensures verification of payable benefits, patient details, copays or coinsurance, and plan exclusions. Verification does not guarantee that a particular service or drug treatment is covered. Prior authorization or prior approval is necessary to acquire reimbursement for most medical procedures and services; this aids in minimizing delayed payments and denials.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, or by phone at 404-633-3777 x820.