We are well underway into the new year, which means all DME’s face the annual challenge of calendar year deductibles renewing on January 1st. It’s vital and courteous to provide your patient/customer with the most accurate co-pay information at the time you render services. One essential component of any DME Intake process is insurance eligibility and benefit verification. This approach will help to improve patient relations as well as a growth in the DME’s collections.
3 Ways to Verify Insurance Eligibility and Benefits During Intake
Here’s an overview of the process for verifying a patient’s insurance eligibility and benefits and common terminology used during the verification process.
1. Verify Insurance Over the Phone or Online
When Intake receives an order from the client, verify the patient’s insurance via phone or online. Most insurance companies have their own provider portal that you can use for verification. Another way to confirm benefits is by calling health plans directly.
Outsourcing Benefit: When you work with the Medbill team, our department will confirm the patient’s insurance for you during Intake.
2. Insurance and Benefits Verification
Intake has two main focus areas that are crucial, the verification of insurance and the verification of benefits. The difference between the two is that when verifying coverage, you need to look and see if a patient has an active policy. Then when verifying benefits, make sure to check to see if that patient has coverage for the specific rendered services. In this case, durable medical equipment.
Outsourcing Benefit: At Medbill, our Intake process is thorough. We do the work for you to ensure the patient has an active policy and that their coverage includes DME items.
3. Obtain Benefit Detail Information
Once confirming that the patient has active coverage and determining if their plan is in-network or out-of-network with the DME facility, you need to obtain benefit detail information. This benefit information will include the deductible, out-of-pocket, and anything the patient has accumulated towards their deductible and out-of-pocket. It also consists of the plan’s co-insurance information.
Here’s some common terminology used when obtaining this information.
A deductible is an amount a patient pays for healthcare services before the patient’s insurance plan starts to pay. Once the patient satisfies their deductible, the insurance would kick in. Then the patient would only be responsible for a co-payment or their co-insurance percentage.
An out-of-pocket (OOP) limit is the maximum amount a patient will pay for their covered medical care and costs, including deductible, co-insurance, and co-payments for eligible services. Anything going towards the patient’s deductible will also go towards their out-of-pocket limit.
Co-insurance is the percentage of costs of a covered service that you pay. For example, if the patient has a 20% co-insurance, the patient will pay 20% of the service allowable.
Outsourcing Benefit: Our team will confirm that you obtain accurate benefit information prior to dispensing. This is crucial to determining the patient’s financial responsibility to ensure efficient patient care with optimal outcomes.
Put Yourself in the Patient’s Mind
Some DME’s may assume that patients understand how coverage works for durable medical equipment (mainly because we look at it all day, and it’s our job). We have to put ourselves in the patient’s shoes and help them understand how much they should expect to pay for the equipment you are providing. No one likes surprises.
Medbill is Here to Help You Meet Your Goals
Implementing a consistent and accurate process during Intake will help to ensure timely claim payments and patient satisfaction. At Medbill, we’re here to help you succeed. Contact a team member to learn more about how our Intake and other DME billing services can benefit your business.