VERIFYING INSURANCE ELIGIBILITY & BENEFITS Flashcards
the 1st step to insurance verification
o Collect the patient insurance information
o Verify their identity with a photo ID
2nd step of verifying insurance elg & ben :
Determine what coverage the patient has according to the specific plan.
o Understanding how the plan pays
o What the patient responsibility (copay, deductible, coinsurance)
this plays a critic role in the revenue cycle…
Verification
What is the dedicated eligibility line?
verification can be done by calling this line if there are no other options
it is a provider that has signed a contract with the payer to accept assignment for services rendered…
In-network provider
it is what the payers have established for ea CPT that providers agree to accept as payment in full when contracted as in-network providers
allowed amount
it’s a provider that has not accepted assignment w an insurance company & pt will pay higher out-of-pocket expenses
Out-of-network provider
it determines which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan
Coordination of Benefits (COB)
this helps to minimize delay reimbursement or denied claims…
Insurance Verification
What is a bday rule?
it is when a child has coverage under both parents
it is determine by the (1) earliest month of the parent’s bday, (2) day as well, then (3) effective the longest
it is the monthly amount the policyholder pays to receive plan benefits…
Insurance Premium
it is the annual amount the policyholder must pay before the insurance plan will begin to pay for benefits
Deductible
When does the insurance start paying for the covered benefits?
when the deductible has been met by the policyholder
these are services offered to the policyholder with the intent to prevent or avoid health problems or injury
Preventive Services
it is a set amount that is paid for visits at the time of visit
Copayments
