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6 Patient Eligibility Verification Best Practices for PT/OT Practices

by | Jul 24, 2024 | Blog

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6 Patient Eligibility Verification Best Practices for PT/OT Practices
For Physical Therapy and Occupational Therapy practices, verifying patient eligibility is indispensable when it comes to billing patients, getting paid by insurance providers, and managing a PT/OT practice’s overall revenue cycles. With the rise in high-deductible and cost-sharing insurance plans, more and more patients are required to make payments at the time of service, though many patients are unaware of this fact. Eligibility verification—particularly when done in advance—solves this problem, allowing you to share important payment information with your patients before their appointments. Below are 6 patient eligibility verification best practices that you can leverage to ensure your operational processes are as effective as possible.

1. Find the Right PT/OT Verification Method

First, each Physical Therapy or Occupational Therapy practice has unique needs and resources for patient eligibility verification. While more traditional verification processes like calling or faxing patient information to insurance providers might work for some smaller PT/OT practices, high-volume practices may find those methods tedious and time-consuming. Alternative eligibility verification methods include:
  • Carrier Portals, databases hosted on providers’ websites;
  • Clearinghouse Systems, databases hosted on third-party websites;
  • Integrated Solutions, integrated directly into your practice management software;
  • Outsourcing, a third-party that runs eligibility tests for you, or purchasing verification automation software;
  • And Inclusive Software Solutions, like pVerify, that offer a web-based Portal, Outsourced Batch Processing, hybrid software Integrations, and API White-labeling.
Regardless of which method you currently utilize, it’s important to consider your needs and resources to decide whether a better solution exists for you.

2. Verify PT/OT Eligibility at the Right Time(s)

In addition to finding the right verification method for your PT/OT practice, ensuring your staff verifies patient eligibility at the right time(s) and establishing a schedule for routine batch verifications is also essential. Though your PT/OT practice should find a schedule that is right for your staff and needs, two occasions are typically recommended as best practice for eligibility tests:  
  • The most commonly recommended time to verify eligibility is when scheduling an appointment with a patient on the phone. This allows your staff an opportunity to clear up any mistakes or gaps in coverage before the patient physically comes into your practice, thereby eliminating the awkward possibility of having to explain why the therapist can’t see the patient that day.
  • It’s also recommended to double-check a patient’s insurance information when they come in for their therapy session, as insurance plans can change in a matter of just a few days.

3. Save Verification Information

Always save your patient’s eligibility verification information. Keep a record of the date and time you called the provider or went to their website, as well as patient and staff information. Being proactive will prepare you for the unfortunate and annoying event of a dispute between you and a patient’s insurance provider. If you outsource your verification processes or use automated verification software, confirm that your vendor or software application also saves this information. pVerify accomplishes this by offering a downloadable PDF as confirmation of a successful Eligibility Verification.

4. Calculate Price Estimates for Patients

After you verify eligibility, use the information provided by the patient’s insurance provider, as well as your PT/OT practice’s contracted rates, to calculate a price estimate for your patient. Just as with verifying eligibility, the sooner you can offer this estimate, the better. If you provide estimates, your patients won’t be caught off guard when you ask to collect a payment, so it’s recommended that you provide them when scheduling appointments. Many automated verification software platforms, like the Patient Financial Responsibility Estimator, will take care of this task for you, saving your staff time and brainpower.

5. Reiterate Payment Responsibility at Check-In

If your staff gets into the habit of verifying eligibility and calculating price estimates for patients over the phone when scheduling appointments, it’s still crucial that they reiterate payment responsibility at check-in and remind patients what out-of-pocket costs, such as co-pays, they need to provide. Your PT/OT practice should also have a written patient payment policy accessible to patients in the office or on your website that can answer most of patients’ billing-related questions.

6. Reassure Patients That PT/OT Eligibility Verification Benefits Them

If you’re faced with any objections when requesting insurance information over the phone (or even at the front desk), ensure your patients that you’re gathering the information to benefit them. Inform them that by receiving the information up front, you can make the process of dealing with insurance providers smoother, provide them with an out-of-pocket cost estimate, and make sure they receive their full PT/OT benefits. (The nice part is that, while this is true, in-advance eligibility verification also helps you!) pVerify is powered by its own APIs — created by healthcare experts for developers. Learn about our hassle-free approach to integrating with existing platforms. Contact our team of experts to schedule a demo today!