Coding Corner Question: Eligibility Quiz for Front Office Staff

1. A new patient calls to schedule a visit with the rheumatologist. What main question concerning financial arrangements should you ask before finishing the call?

1. How did you hear about our physician?
2. What is the name and contact information of your insurance carrier?
3. Is this a referral?
4. How much is your copay?

2. A patient has been seeing the rheumatologist for six months and calls to schedule his first infliximab infusion in one week. What should you do?

1. Take the patient’s copay or coinsurance.
2. Inform the patient how long the procedure will typically take.
3. Contact the insurance carrier to find out benefit guidelines, i.e., prior authorization request and benefit level.
4. Nothing, the patient has been coming to the practice for six months.

3. The patient is on his third infusion, so insurance eligibility does not need to be checked because benefits were verified for the first infusion.

1. True
2. False

4. You verified eligibility when the rheumatologist ordered the infliximab infusion two weeks ago. The patient comes in for infusion today. Should you verify eligibility again?

1. Yes
2. No

5. Should eligibility be verified on every patient on every visit?

1. Yes
2. No

Click here for the answer, and see “Dos and Don’ts of Verifying Insurance Benefits” for more on this topic.