The eligibility checks that pay for themselves

Registration is not verification

A practice that checks coverage when a patient is first registered and then trusts it is running on data that decays. Plans end. Employers change carriers in January. Medicaid lapses at redetermination. Medicare Advantage enrolment moves and the claim goes to the wrong payer entirely.

The three codes this produces

CO-27 — expenses incurred after coverage terminated

The plan ended before the date of service. Worth knowing: if you verified and hold the transaction record, many payers and most state Medicaid programmes will honour a documented verification even when coverage was terminated retroactively. Keeping the record is the entire defence.

CO-22 — may be covered by another payer

Coordination of benefits is stale on the payer’s file. Call the patient before you call the payer; they can usually fix it in one call and the payer will not update it on your say-so.

CO-109 — not covered by this payer

It went to the wrong place. Most often a Medicare Advantage plan billed as traditional Medicare. These cluster in January, which means a practice that re-verifies every January prevents most of a year’s worth.

The arithmetic

An eligibility check takes a couple of minutes. A denial arising from a missed one takes a call, a correction, a resubmission and thirty to sixty days of delay, and sometimes ends as a write-off when the filing window closes. The check is the cheapest denial prevention available and it is skipped precisely because it is dull and the cost of skipping it arrives two months later, attached to somebody else’s work.