General Category > General Questions

Eligibility & Benefits Checking

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PMRNC:
Maybe asking how you charge in general is a better way to determine if you are being compensated for taking that extra step to verify benefits. As I said earlier, I do not use online verification because they are inefficient and incomplete for all the reasons and more than you stated. If you are charging a % of collections and your contract includes full practice management the verfiication of benefits should be done and should be complete as it is the very first and most crucial part of the biling process. That said if you are billing a % than I would say you should be doing these and if making the call is the way to get the proper and needed information you should do so. If you are charging any other way, look at your contract to see if your contract actually defines the services for full practice management. IF your contract is specific that it only includes the verification via the PM online verification system BUT it's not contributing to the proper reimbursement for your client you might want to modify the contract and include the extra step to call and adjust your charges to compensate for this service.

Online verification systems are ONLY good for checking eligibility, they ALL fail in that they do not provide the necessary information to determine many critical elements needed in case of an appeal. This is especially true for many specialties! 

spectramedi:
Thanks Linda for such an elaborate explanation. Were thinking it's only us getting stuck on this :)

You clearly made some valid points on the compensation and contract side.

Thanks again.
Cheers!

spectramedi:
Hi,

So is the "PROFESSIONAL" and "SPECIALIST" the same?

Our provider is a neurologist and wants the benefits for Specialist Outpatient visit... but when checking online or in faxed document there is no Neurology mentioned in the specialties and no Specialist Office Visit category... but there is a section for Professional (Physician) Visit - Office.

Thanks.

PMRNC:
If there are no specialty's listed than it would be "professional". Depending on whether you are checking benefits for something in particular for example surgery, etc..that would be one reason you might want to call if there is no option for specific benefits. Again, since I don't do online benefits at all I am unsure, but most likely each carrier will have their own criteria to search by specialty/profession, benefits, etc.

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