Checklist for Insurance Eligibility Verification

by | August 10, 2021 | 5:57 am
Insurance Eligibility Verification Checklist

It is important to complete insurance eligibility verification so that DME/HME businesses avoid unpleasant surprises during claim processing. Claim for payment may be denied if the patient is not eligible, the coverage has expired, or if the service is missing from the insurance coverage.

The onus of verifying insurance is on the DME/HME.

Here are some considerations regarding insurance eligibility verification:

  1. Using the insurance verification checklist

DME/HME staff need to ensure basic details are diligently recorded at the time of insurance verification. This information can be obtained directly from the insurance card, while other details may be elicited by speaking with the insurance providers.

Some of the details that need to be entered into patient system include:

  • Insurance details including ID, number, correct name of the individual insured
  • Policy details such as limitations to coverage, any specific documents needed for billing
  • Information about whether or not your DME/HME is participating in the plan
  • Details of relationship with the patient, if the insured individual isn’t the patient
  • Validity of the insurance in terms of date, including date of expiration
  • Claim address and updating of any changes to contact details
  • Requirement of pre-authorization, if any
  • Details of whether there is a co-pay involved and the amount of deductible
  1. Conducting due diligence

For all the information listed in the point above, businesses need to conduct due diligence, possibly verifying patient information with the insurance company.

If you have an electronic medical records repository, you can efficiently import data without losing information.

  1. Recording details directly from insurance card

Even after manual recording of information, making a copy of the patient’s insurance records can be a useful back-up. At the time of filling in the claim application, details can be cross-verified if required.

A copy of the patient’s insurance card can also help in the case of any changes in the patient’s personal life such as divorce or change in dependents. Events such as birth, marriage, and divorce can change insurance coverage, and thus need to be reviewed carefully.

Insurance Eligibility Verification Checklist Infographics
  1. Reviewing patient information periodically

Insurance eligibility verification should include periodic checks to record any changes or modifications to existing information. This might include the need to communicate with the DME/HME customers to ensure they are on board with changes in insurance information.

Insurance premiums may also change, even if nominally. Communicating with patients to ascertain these changes helps ensure they are aware of changes and are not surprised.

Why you should consider professional HIPAA-compliant medical billing

Medical billing assistance can help DME/HME businesses to stay on top of insurance eligibility verification. Professional assistance can help your business with technical details such as accurately completing eligibility verification, ensuring a smooth claim process, and keeping up with revenue cycle management.

Medical billing services can be diverse and cumbersome. Choosing one that fits your unique business needs can help boost profitability by streamlining processes including insurance eligibility verification.

Next Steps

  • A DME partnership can provide the right assistance and expertise to reliably manage DME/HME billing requirements, including data management, so that the business can continue to focus on providing quality healthcare.
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