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The Front Desk, lesson 1 of 3
Check Eligibility at Every Single Visit
Medicaid eligibility is decided month by month. A patient who was covered in March may not be covered in April, through no fault of theirs and with no letter you will ever see. Checking at every visit is not caution. It is the single highest value habit in a practice like this.
- The fact. Eligibility is monthly, not permanent
- The habit. Check before every appointment, every time
- Also check. Which program and which plan, not only yes or no
- Keep. The response, saved against the date of service
Why Coverage Moves
People move on and off Medicaid for ordinary reasons. Income changes, a job starts, paperwork is not returned, an address change means a renewal letter went to the old place. None of that reaches your office.
The patient usually does not know either. Somebody who was covered at their last cleaning has no particular reason to think anything has changed, and will tell you in good faith that they are on the program.
So the patient's answer is not a check. The program's answer is the check, and it is only good for the period it covers.
What to Look at Beyond Yes or No
Whether they are covered at all is the first question and not the only one. The response also tells you which program they are in, whether a managed care plan holds them, and sometimes whether there is other coverage that pays first.
Other coverage matters more than practices expect. When a patient has commercial insurance as well, there is usually an order in which the two are billed, and getting it backwards creates a denial and a rebill for no reason.
If a plan holds the patient, that changes who authorizes work and who you bill. Finding that out at the front desk is cheap. Finding it out from a denial is not.
Making It a Habit That Survives a Busy Morning
Check when the appointment is booked and again on the day. The booking check protects the schedule. The day of check protects the claim, because the month may have turned in between.
Save the response against the date of service rather than just reading it. When a claim is questioned months later, a saved eligibility response from the right day is the whole argument.
Write down what the front desk should do when the answer is no, before it happens. A person standing at the desk who has taken a morning off work deserves a real answer, and the worst version of this conversation is the improvised one.
Confirm how and where to verify with your state program. There is normally an online system, and the details of it are the program's to publish rather than ours to describe.
Before You Spend a Dime
The patient says they are still covered. Is that enough?
No, and they are usually not being untruthful. People are rarely told promptly when coverage lapses. Only the program's own answer counts.
What if eligibility ends between approval and treatment?
That is exactly why the day of check exists. Approval for work and coverage on the day are two different things, and both have to be true.
What do we tell a patient who is no longer covered?
Tell them plainly, tell them the visit can be rescheduled, and point them at how to re-enrol. Decide the wording as a practice in advance so it is the same every time.
Next Problem to Solve
- Building a Schedule That Survives a Broken AppointmentNext in the course. Broken appointments are structurally higher in this population and mostly are not about motivation. How to build a day that absorbs them instead of one that breaks.
- Fee for Service or Managed Care, and Why It Changes EverythingRelated. The two ways a state pays a dental practice for the same patient, and how the choice changes your front desk, your cash flow and who you answer to.
- A Denial Is Almost Always a Document ProblemRelated. How to read a denial, sort the ones worth reworking from the ones that are telling you something, and stop the same denial from arriving again next month.