5 Points on Addressing Medical Practice Eligibility Issues

A Physicians Practice report discusses five points on addressing and resolving medical practice eligibility issues with payors.

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  • Obtain the original insurance verification completed by office staff.
  • Write a letter of appeal that includes the payor representative’s name, the date and time, and the name of the front office staff member.
  • Retrieve facts surrounding the patient’s visit, how complicated the case was and any tests ordered.
  • Explain how the practice is saving the payor money, such as by sending the patient to physical therapy or designing a home exercise program.
  • Summarize what is being asked for, such as six outstanding claims that must be paid in full by the payor and why.

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