Take steps to verify your patient’s insurance eligibility

Take steps to verify your patient’s insurance eligibility

Seeing patients with citizenship or immigration issues means you might not get paid for your services. This is why it's more important than ever to verify your patient's benefit coverage.

"ODs should consider verifying this information before a patient is actually examined and treated."

The Centers for Medicare and Medicaid Services (CMS) recently announced that its federal health insurance exchanges, or marketplaces, were sending out notices to consumers who might have "data-matching" issues on immigration status or citizenship but had not responded to previous inquiries.

This action serves as a reminder to ODs to stay on top of verifying their patients' insurance eligibility and specific benefit coverage options, notes Richard Soden, O.D., a member of the AOA Third Party Center Executive Committee.

"Although patients are responsible for knowing their individual and family insurance plans and specific benefit options, ODs should consider verifying this information before a patient is actually examined and treated," Dr. Soden says.

CMS is giving consumers until Sept. 5 to submit supporting documents to verify their eligibility for coverage on the exchanges. Failure to do so means their coverage will end Sept. 30.

Such problems arise when a consumer's application either has incomplete information about a Social Security or Permanent Resident Card number, or the information differs from what's on government records.

"A data inconsistency does not necessarily mean there is a problem with an individual's eligibility for enrollment; it means that additional information is needed to verify the information provided in an application," a CMS press release stated.

Do your homework on patients, exchanges
In light of this new deadline, Dr. Soden recommends that ODs set up a specific procedure to find out if patients have the insurance they say they have.

In the event a patient doesn't have legitimate citizenship status and seeks treatment from an OD, saying they're covered on an exchange plan, the OD might not get reimbursed, Dr. Soden emphasizes.

Practices should also try to obtain specific insurance information such as deductibles, copays and exclusions, for the different plans on their respective state exchanges.

With so many options available within a specific plan on the exchanges (e.g., bronze, silver, gold, platinum levels), "it is important for the office to try to obtain as much information as possible prior to the examination," Dr. Soden advises.

August 29, 2014

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