To know more visit, https://conferencepanel.com/conference/understanding-patient-s-eligibility-copays-co-insurance-deductibles-and-past-due-balances-2023-changes Insurance changes are upon us with January 1st right around the corner. Now is the time to review your internal processes and be sure your team is ready for the upcoming changes and prepare if not! Every healthcare practice must verify coverage before services, especially in the new year. If needed, we can implement new protocols within your office to be more proactive about patient copays, co-insurance, deductibles, and even patient past-due balances. Our speaker will give real-world examples of processes successfully implemented at busy practices across the country! Common errors, top training tips, and a detailed checklist for eligibility verification will be covered in depth. Be sure to attend this MUST SEE webinar, it will bring your practice revenue improvement tools for the upcoming 2023 year!

1. Understanding Patient`s Eligibility, Co-pays,
Co-Insurance, Deductibles and Past Due Balances
2023 Changes
STEPHANIE THOMAS, CPC CANPC

2. Objectives
• What is patient eligibility?
• Information obtained during checks
• Understanding eligibility reports
• Implementation of processes
• Preauthorization and referrals
• Tips, checklists, common errors
• Patient involvement
• Q&A

3. Insurance
Verification
▪ Call or check online (Availity, direct on payer
site)
▪ Most PM Software can check right from the
patient demographic page
▪This tells you if the patient is eligible and if the
information you have is accurate

4. Demographic Information
▪Verify these at every visit
▪Obtain Social Security Numbers
whenever possible
Obtain the correct
▪patient address
▪phone number
These are the KEY
to getting you paid!
Copies of
insurance cards-
keep current!
Don’t delete old
cards!

5. What are we looking for???
1. Is patient eligible for this date of service
2. Current benefits
a. Deductible
b. Copays
c. Coinsurance
3. Any HMO coverage (Medicare and Medicaid patients)
4. Any other coverage (issues with COB)

6. Referrals and Pre-authorization
▪ Tricare, Medicaid plans, even some BC
plans require this even on the first visit!
▪ Most plans require authorization for
testing and procedures.
▪ Inquire on every patient, every time.

7. Other common problems
oThird party administrators-entered incorrectly
oSouthwest Service Administrators
oMultiplan
oFirst Health
oTeamcare
oIncorrect payer ID’s or identifiers in software
oSubscriber info, relation
oAllowing system to “auto-check”-be sure to review results!

8. Collection of Patient Responsibility
▪ Be sure your staff collects co pays, coinsurance amounts, deductibles and past due balances
every visit.
▪ When calling/checking for insurance verification this information is typically given.
▪ It is recommended to provide this information to the patient when calling to remind them of
their appointment the day prior, so they are prepared to pay.

9. Identify
Denial Trends
Quickly
▪ Have an open and close relationship
with your billing department
▪ It is recommended to have monthly
meetings to review denials and claim
issues seen due to eligibility referrals
and authorizations

10. Prepare Copay/Collection Log

11. Checklist for eligibility and patient account
success!
➢Payer websites working
➢Availity
➢UHC Online
➢Local MAC
➢State Medicaid
➢One Health Port
➢BCBS (if not through Availity)
➢PM software set up properly to run eligibility AT LEAST 2 days prior
➢Prep work for copay/collection log (training or obtain from billing team)
➢Training/help sites for when eligibility function is not working properly
➢Coverage plan for vacations/sick

12. Questions?
Stephanie Thomas CPC CANPC
stephanie@elitecodingandbilling.com
Register Now