To verify Sylvia Baker’s insurance, Lewis can either call the insurance company to verify patient coverage if using the paper-based method. If Lewis is using an EHR, he can electronically confirm the insurance coverage via secure internet site or direct portal. Even if Sylvia has been seen before, there could have been a change in her insurance policy and can cause claims to be denied. He needs to make sure that Sylvia is covered for the type of procedure or service she will be receiving. He should also find out the amount she will be paying for a copayment or coinsurance. If he is using the paper-based method, he will then write down the patient’s information on a benefits verification form. If Lewis is using and EHR, he will update all of Sylvia’s information into the computer system.…show more content… He needs to make sure he verifies every patient’s insurance because failing to do so can end in no payments for a costly procedure.2. List some reasons the claim for Mark’s care could have been rejected.Mark’s care could have been rejected for several reasons. If for some reason the claim was not preauthorized, it would have been denied. You should always verify the insurance and get a procedure preauthorized before continuing service. The patient may no longer be eligible for coverage, so you always need to make sure you are calling to verify patient coverage. You could also run out of authorized sessions if the insurance had approved a certain amount of preauthorized sessions. Seeing that the codes, quantities and modifiers were all correct, another reason for rejection could be that the claim was not submitted in a timely manner. All claims should be filed within 30
