Claims Management Tip: Your Ultimate Coverage Checklist

claims management checklistWhen checking patient eligibility, many practices simply check the coverage of the scheduled procedure for that day. If your practice checks eligibility this way, you could be hurting your workflow. What if the OD discovers an issue of concern during the exam and decides that additional testing is required? Most patients will only want to proceed if the test is covered by insurance, and if your front office is only checking basic eligibility, your workflow will be put on pause while you look up additional coverage.

The solution to this bad claims management habit is to have the front desk check complete eligibility prior to the exam, that way the OD has the answers to patient questions as they come up in the exam room. This will help your workflow continue in an efficient and timely manner. There are four different eligibility checks the front desk should complete before any patient's exam. Let's take a look.

Claims Management: The Ultimate Coverage Checklist Your Front Desk Needs

  1. Is the routine vision exam covered?
  2. Are specialized visits and diagnostic testing covered?
  3. Are office surgeries (codes that start with 6) covered?
  4. Are radiology procedures (codes that start with 7) covered?

By having the answers to these four questions during an exam, the OD can recommend and conduct additional procedures and tests that the patient might need. This way, the OD won't have to waste time during the exam trying to figure out what exactly is covered; they can focus on providing excellent patient care.

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