Cheapest methods for checking patient Eligibility

I am going to talk about a busy 3 doctor pediatrician office to explain why eligibility is extremely important. I was able to clean up the practice from about 80% in clean claim submission to about 95% clean claim submission under 45 days. With this part knocked out the biggest issue I was finding is that new born babies were my 3% of claim denials for not being eligible.

This practice has a strict policy that all patients are self-pay until the baby is added to the insurance plan however; the front office had not been checking eligibility for any of the patients and just taking the insurance card. The reason for not checking eligibilty - TIME.

So I reviewed what it would cost to check eligibility:

Practice Management Software Eligibilty search through RelayHealth: Our PM software charges $250.00 setup for the practice and $.45 cents an inquiry $39.00 a month per provider for unlimited eligibility status. Not all patient searches come back with documentation and those still need a phone call or website search but over all it is quick and efficient. It is not the cheapest eligibility search on the market (I have seen some that charge more like $.20 - $.35 cents a inquiry) but it works.
$117.00 a month ($39*3) for unlimited eligibility

Phone: This practice does not treat Medicare or Medicaid patients so that was a plus. We figured it would take about 30 minutes an inquiry and at 35 patients a day that would take 1050 minutes or 17.5 hours (over 2 man hours to check eligibility). This of course was not a option but we know that the success rate of calling insurance carriers are extremely high at getting the correct information the first time around.

Fax: Fairly inexpensive however; we need to complete it well in advance and not all insurance carriers accept Fax. We figure it takes 10-15 minutes per patient. 35 patients a day and maybe of these only 10 of their insurance carriers will accept faxing.

Online Eligibility through insurance carriers website: Quick, efficient and extremely accurate. I really like this method however; it does still take time but it can be done in the evenings and early mornings. If you have a internet savvy employee they can quickly get through 35 patients in 7-8 hours. 35 patients x 10 minutes /60 min in a hour.

IVR (interactive voice response): Phone calls to insurance carriers that have eligibility IVR are another good reliable source for eligibility. Of course you need to call during the operational IVR hours and sometimes you will get through all of the prompts just to find out that the system is down. 5-15 minutes a phone call per patient.

Insurance Card Swipe: Some insurance carriers like United Health Care have a swipe on the back of their insurance card that you can run through your credit card machine. Be aware that their are credit card fees which vary per contract and sometimes the information you recive is not extremely helpful.

Have the Patient Complete it: some offices require the patients to complete their own eligibility check. This doesn't cost the office anything unless you get a angry patient who decides to go to another practice because of the inconvenience this causes them.

We went with the online eligibility search through the practice management software and that has helped a lot. My claim exclusions for non-eligibilty has gone down and the front office feels like they still have time to complete their other office duties. Of course when they get behind I don't mind checking a handful through the online website option and notifying them of what I have found. The point is that we are now at 98% clean claims submission and the doctors have never been so happy!

My recommendations is to do a little bit of all of them since Eligibility is an important part of collections. In a busy medical practice you have to give people options to completing them while also identifying the Financial Aspect to the options. Let me know if this helped you at all.

If you are looking for Practice Management Software vendors that have online eligibility you can visit http://www.medicalbillingsoftwarepro.com/ and scroll down the navigational bar until you get to the Web-based Medical Billing Reviews or the Server Medical Billing Reviews. Click on these links and search away.

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