• Practice Solutions

THIS is Why You Need Eligibility Checks


Main Points

  • A verification of benefits (VOB) is a way to ensure the services that you render will result in payment from the insurance company

  • A VOB is important because it helps you to estimate what the patient owes and what the insurance might pay you

One of the most important parts of the revenue cycle management process is conducting a verification of benefits. This process is very important for several reasons including the perception that you are providing a luxury service to your patients. You can be seen as removing a large barrier from the patient receiving care, and the importance of that can hardly be overstated.

Since therapists want to provide great services to patients including dealing with insurance for them, providers need to understand how to do a VOB and understand that pitfalls that overshadow the process.

However, in order to provide this service to patients, providers must first understand what a VOB is and its importance to the revenue cycle.

A verification of benefits (VOB) is a way to ensure the services that you render will result in payment from the insurance company. This is really the first step in ensuring payment from both the insurance company and the patient.

If you don't first verify if the patient's plan is active then you certainly won't be paid for your services. Essentially, this means that you are going to find out if the patient is current on their premiums and has active coverage through Medicare, Medicaid, or some other plan that they subscribe to.

Then you are going to verify if you are in-network or out-of-network with that patient's plan. Here are the necessary documents you will need in order to conduct an eligibility and benefits check:

  • A copy of the front and back of the patient's insurance ID card

  • The patient's first name

  • The patient's last name

  • The patient's date of birth

Once you have this information you will want to save it in your EHR for future reference.

Finally, you will want to call the number on the back of the insurance ID card to get the correct benefit information. This will ensure that you don't receive denials based on your network status or if the patient's coverage is terminated.

A VOB is important because it helps you to estimate what the patient owes and what the insurance might pay you. When you get an insurance representative on the phone, things might get a little funny. You will be asked for your National Provider ID (NPI) and for the patient's information.

Then you will be asked what benefits you are looking for. It is important to tell them that you are looking for outpatient mental health benefits rendered in an office setting. This tells the rep exactly what to look for when giving you benefits.

What you need to look for is what the patient will owe and what the insurance company will pay you. This information will not be as obvious as you think!

You will be told whether the patient has a deductible (e.g. the patient will owe you for the allowable amount for the session). and/or what the patient owes for a coinsurance or copay and what their out of pocket expense is for the year.

Once you know all this information you will have a complete understanding of the patient's benefits and you should be paid by both the insurance company and the patient

This process can be very confusing and disorienting, but if you create a firm process that involves VOBs at the very beginning you will have a great start to getting paid by both patient and by insurance company.

If you find that you have questions about the VOB process, feel free to reach out to us here to ask us some more questions! We would love the opportunity to be able to help you understand this process better.

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