Verification of Benefits

When a medical practice fails to complete a proper verification of a patient's benefits, the stage is set for an insurance claim denial and a potential loss of money. Often patients will present an expired insurance healthcare card at registration and then never make payments to the doctor's practice. Other patients may change their supplemental insurance during the year and present the wrong insurance card by mistake. Either way, PCL can implement a time-tested process for handling verification of benefits and train your staff to recognize suspect insurance card fraud. Don't waste your physician's hard earned money by failing to follow proper procedures when verifying the healthcare benefits of your patients.

Physician losses continue to mount not only in Florida but nationwide, as patients present insurance cards that are no longer in effect, or were never in effect. It is almost impossible to collect money from a patient that strives to deceive your practice. That is why at PCL, we stress the importance of verifying insurance benefits on patients before they come into the office. Waiting until after a claim denies for "non-effect" is too late. As with many medical offices, staffing prohibits the verification of benefits, even though logic tells them it is important. At PCL, we can verify benefits for you before the patient presents into the office. The information will be loaded into your database so that your staff can be ready to collect the appropriate copay, deductible, coinsurance or full balance due at the patient visit. If we find the patient's coverage is terminated, you will know it and can make sure the patient updates their insurance information prior to being seen or pay for the visit.

We provide verification of benefits information to include the following:

PCL always operates as a physician's advocate when working with your personnel to ensure that your practice can bill, submit and collect for medical services rendered. We understand the importance of getting the "whole story" when verifying insurance benefits for your patients. Although it is illegal in Florida, some patients still present healthcare cards that are no longer in effect. A failure to identify fraudulent cards at registration or during appointment scheduling can cost your practice thousands of dollars.

PCL also wants you to be aware that patients generally don't understand their insurance coverage and benefits and are not necessarily trying to deceive. This lack of understanding is another good reason to verify benefits. Medicare patients, for example, may go from the regular Medicare product to a Medicare Advantage Plan and still present just their government provided Medicare card in the office. If the office doesn't verify benefits they will not know ahead of time if they should have collected a copay or gotten an authorization for services rendered. They would also be billing the wrong insurance company and either delaying or preventing payment. Medicaid of Florida is another prime example of why benefits must be verified. If a patient makes an appointment stating they have Florida Medicaid, but fail to tell you they have a Medicaid PSN or HMO product, you again would not know to obtain an authorization to see the patient. If you don't verify benefits you would also not know if the patient is eligible in the month they are being seen, as this can and will change from month to month. And, once again, the claim would go to the wrong insurance company.

Allowing PCL to take care of this very important step will most certainly increase your revenue and allow the physicians to take care of the patients, knowing they are getting paid for the services they render.