When should a medical insurance specialist check patients' Medicaid eligibility?

Checking a patient's Medicaid eligibility each time an appointment is made is essential for ensuring that the office has accurate and up-to-date information regarding the patient's coverage. Medicaid eligibility can change frequently due to various factors, such as changes in income, family status, or residency. By verifying eligibility at the time of scheduling, the medical office can avoid potential billing issues later, ensuring that the services provided are covered under the patient's current Medicaid plan.

This proactive approach helps to minimize the risk of claim denials when the billing takes place after the appointment. If the specialist were to wait until check-in or until the bill is sent, it might lead to complications, including unexpected costs for the patient or the need to reschedule appointments if coverage is not confirmed. Regular monthly checks also do not account for the dynamic nature of Medicaid eligibility, which can fluctuate from one appointment to the next. Therefore, confirming eligibility at each appointment scheduling aligns with best practices in medical billing and patient care, ensuring a smooth process for both the office and the patient.