Claim Management Tip: Avoiding Denials Due to Coverage Termination

Posted by Janelle Pauli on Tue, Dec 15, 2015 @ 10:12 AM

We've been serving up claim management tips all month to help you avoid denied claims in your practice. Today, we want to talk about denied claims due to coverage termination. Insurance coverage termination can be a result of a couple of different things. It can be caused by a patient getting a new policy or dropping their plan, or due to late or non-payment on monthly paid premiums. Read on to find out why this happens and how your biller can avoid seeing this denial in your practice.

Don't Let Coverage Termination Denials Disrupt Your Claim Management

The first step in avoiding claim denials is understanding why they
happen in the first place. If you're diligent claim managementabout pulling patient eligibility and still receive a denied claim it could be because you checked the eligibility information too early. 

For example, a policy might be active in March, but if the appointment is scheduled for April and the patient misses their insurance payment that month you will get hit with a denied claim because the patient is not covered by insurance during the time of the appointment in April. 

Your biller should be aware of the types of insurances that are paid on a monthly premium so that they know the right times to check for eligibility. If we look at Medicaid, the insurance plan becomes active at the beginning of the month as the plan renews. Your biller should be checking for eligibility at the beginning of the month for any medicaid patients. While it's important to check eligibility ahead of time, it's just as important to make note of the plans like Medicaid and check eligibility again once it's closer to the appointment. 

One strategy for avoiding these denials would be to set up a policy not to see Medicaid patients for the first five days of the month, depending on how busy your practice is. Planning around the first five days of the month would give your biller plenty of time to check eligibility before the appointment. It is within your legal rights to limit patient appointments based on insurance, but to avoid complaints simply ask for their insurance plan before providing them with appointment availabilities in your practice.

Looking for more claim management tips? Download our latest eBook today! 

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Tags: Practice Efficiency, Resources, Coding & Billing

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