What is Eligibility and Benefits Verification?
Healthcare providers have to check if a patient is allowed to get treatment before they can get paid. Lots of times, when claims for payment get turned down, it’s because the patient can’t get the treatment. This is often ignored in the process of getting paid for treatments.
Pulmonary medicine is the specialty that focuses on helping people with respiratory challenges involving the lungs and bronchial tubes. Pulmonologists typically care for patients with more complex pulmonary disease; who are critically ill or injured; or who have a sleep disorder.
They are responsible for:
Receive patient schedule from the healthcare provider’s office – hospital and/or clinic
Perform entry of patient demographic information
Verify coverage of benefits with the patient’s primary and secondary payers:
Coverage – whether the patient has valid coverage on the date of service
Benefit options – patient responsibility for copays, coinsurance, and deductibles
Where required, the team will initiate prior authorization requests and obtain approval for the treatment
Update the hospital’s revenue cycle system or the patient’s practice management system with the details obtained from the payers
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