Mind This Advice if Eligibility Denials Are All Too Common

Patients who are ineligible for benefits that you thought they had are a potential headache for every medical practice. In fact, some experts say it's the most common billing mistake that medical practices make that is causing them denials or recouped payments. Eligibility denials are by far the most common denial.

Here are some tips on reducing eligibility denials:

Get rid of simple mistakes on the front end. Typos in the patient's demographic information, incorrect choice of claims address or electronic payer ID number, etc. - can cause major headaches on the back end.

Due to the exponentially larger volume of health plans on the market since the ACA, growing popularity of third-party administrators (TPAs), and the trend in carrier mergers or consolidations resulting in changes in electronic and/or paper claim submission addresses, it is more difficult than ever for reception staff to determine the right place to file a claim for a given patient.

Go past insurance cards to verify patient info. Insurance cards don't always tell the whole story. It is vital that practices verify eligibility on every patient, preferably at every visit or at least once every 30 days or every calendar month.

You can verify a patient's eligibility electronically for most payers, "provided that the practice takes the time to set up their practice management system properly.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.