Insurance Verification and Patient Demographics

Usually, front desk personnel verify insurance and patient demographic information. This is vital to the revenue cycle.
When a patient walks through the door, reception is the first point of contact. Patients will complete necessary paperwork and return it to the receptionist. The patient’s identification and insurance card must be copied and placed in the chart. These should be verified at each encounter. Instead of asking, “Has anything changed?” ask the patient specific questions. For example: What are your home address and your current insurance? If the patient is a returning patient, verify the insurance with the information you have on file prior to the patient’s appointment, so you can review and correct any discrepancies.
Be sure reception reviews the documents for accuracy and legibility. Failure to do so can cause billing and compliance issues. And if reception is not able to read the documents, neither will the charge entry person.
If the receptionist/scheduler has performed the insurance verification, and the patient does NOT have coverage, the receptionist should inform the patient that full payment is expected at the conclusion of the service. The receptionist should provide an estimate of the fee and, if necessary, reschedule the patient.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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