Remember to Verify Patients’ Eligibility and Benefits in the New Year


With the new year soon upon us, doctors are urged to be diligent in verifying patients' eligibility and benefits to help ensure they will be paid for services rendered. The beginning of a new year also means that both calendar year deductibles and visit frequency limitations reset. And, with the January 31 end of California’s open enrollment period, patients may even be covered by a new payor.

The new year also brings a host of other challenges that could affect your ability to be paid:

  • On January 1, 2018, Health Net Federal Services (HNFS) began providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. HNFS will be taking over the contract previously held by United Healthcare Military and Veterans’ Services.
  • The Covered California open enrollment period began November 1 and ended January 31, 2018. While Covered California will maintain its relationship with all 11 health plans that participated in the California exchange in 2017, Anthem Blue Cross is exiting the exchange market in all but three regions in 2018, citing market instability. This will impact over 150,000 enrollees.

Don’t get stuck with unnecessary denials or an upset patient. Before the patient arrives obtain updated insurance information and verify eligibility at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit.

And, don't forget that deductibles are typically based on the calendar year and reset on January 1. Best practice is to communicate with patients upon scheduling to remind them that their plan has a deductible that may have reset on January 1 and, if that is the case, that payment will be due at the time of service. If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice, as your ability to collect can decrease significantly after the patient leaves the office.

Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money.