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    MGMA Staff Members
    The following excerpt highlights members’ advice for dedicating staff and resources to verify patient eligibility and benefits before the patient’s scheduled appointment. Read the full discussion in the MGMA Member Community.

    We are looking at creating an eligibility team that will be "housed" in billing. We believe taking as much off the front end will eventually help the back end (denials, edits, etc.). This team will preregister appointments. Has anyone ever tried this? Pros and cons? Does anyone have a job description they would be willing to share? Thanks in advance for your expertise!

    Mary Jane Sledz, MPA, MGMA member, director, revenue cycle administration, UBMD Internal Medicine, Buffalo, N.Y.


    I have this sort of scenario in place in several practices and large groups. Yes, it does work, but it is only one of the many tools in my arsenal of weapons against accounts receivable.

    The size of the practice and your billing/practice management software will determine the needs of this position. For instance, our software electronically checks eligibility on the majority of our patients two days prior to visits. We have trained all our business office staff how to determine eligibility and benefits, thus allowing anyone to calculate a patient’s out-of-pocket expenses, which are collected prior to a visit and/or services/procedures. The crossing-training is to ensure coverage with absences, etc.

    For me, there are no "cons" related to this other than the fact that it’s an FTE (full-time-equivalent). But that being said, that FTE has multiple roles and saves me mega-collection efforts.

    There have been several discussions about this subject recently in the Financial Management discussion group (of the MGMA Member Community) with some great suggestions. You might want to take a look at those as well. There are also some job descriptions in the library that might help.

    For this practice, we use a floater who works with both the business office and billing department in a coordinated effort. We determine eligibility and benefits one to two days in advance via our scheduled appointments. (Walk-ins are done on the spot prior to a visit.)

    One thing I will tell you is that the job is very tedious. You spend hours on the phone or websites looking up information, which is another reason we cross-train. We rotate staff so they don’t get burned out.

    Karen Young, CMM, CMPE, MGMA member, chief operating officer/administrator, Brownsville (Texas) OB/GYN Associates

    We have our schedulers take all the insurance information and put it into our practice management system when they book the appointment.

    Our practice management system runs electronic eligibility checks for all appointments booked two days before a patient’s appointment. I have a staff member (a receptionist) go in daily and verify the ones who cannot be checked electronically. That same staff member also calls patients … [if the research reveals they are inactive] to obtain their new insurance information and verifies it while the patient is on the phone.

    Same-day add-on patients are verified by the billing department when their appointments are made. (The scheduler keeps the patient on hold while she notifies the billing department and we verify eligibility, mostly electronically, through our practice management system.)

    I don’t have a job description but I can say it is absolutely worth doing eligibility checks upfront. If your practice management system doesn’t do it electronically, it is something you should request.

    Christina Wagner, CMPE, CPC, CPC-H, CGIC, MGMA member, billing manager, Connecticut Gastroenterology Consultants, P.C., Branford, Conn.

    I am working with a client who has a central eligibility department. The process does work very well with the front desk/appointment scheduler collecting the insurance information and initiating the eligibility request. This particular client is a multispecialty practice with 40-plus practice locations in two states. [The process is outlined in the MGMA Member Community thread.]

    Michael Stipelcovich, MBA, MGMA member, Houma, La.

    We recently incorporated the eligibility process in our billing department’s responsibilities and found that it was easily done through our vendor’s websites once you log in to all of your portals. Our staff members would have two windows open at once. They would copy a patient’s identification [information] from the practice management software into the portal and retrieve eligibility information, which they would copy and paste into the practice management scheduler. It does go much faster and is more efficient if you have a clearinghouse that has this function available. This gives you one portal to work in instead of having to log in to many.

    Kelli Sizemore, RMA, CMPE, MGMA member, chief operations officer, Selah Medical Center, PA, Boise, Idaho

    Additional resource for the staff dedicated to checking elegibility
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