patient eligibility verification in ny obgyn

Steps for Patient Eligibility Verification in NY ObGyn to Boost Revenue

Patient eligibility verification is the foundation of indispensable pillar revenue cycle management, particularly for ObGyn practices operating in New York’s dynamic healthcare landscape. Ensuring that patients are eligible for the medical services that they receive is paramount in a medical practice. A well-designed, multifaceted billing process mitigates risk and bolsters revenue by optimizing billing procedures and reimbursement.

Accurate Data Facilitating Patient Eligibility Verification in NY ObGyn

“Always be prepared” is an important motto. In a busy ObGyn practice, that includes checking for proper insurance coverage. Unfortunately, ensuring patient eligibility verification is often a multi-step process, from recording accurate demographic information to interpreting insurance policies.

Here are a few suggested steps for patient eligibility verification in a New York ObGyn practice:

  • Record Patient Information. One thing is certain in a medical office: Things change. Collecting and updating essential patient demographic details regularly is an easy way to keep your records current. This ensures the accuracy of unique identifying information, such as name, date of birth, address, contact number, and insurance plan.
  • Verify Insurance Coverage. Contact the patient’s insurance company to verify coverage. This is easy through online portals, phone calls, or electronic eligibility verification services. Initial minimal verification double-checks the contact details, but it also provides an understanding of the number and types of services that the plan covers before they become necessary. Understanding coverage also allows the patient to make informed choices about their treatment pathway.
  • Determine Patient vs. Subscriber. It is not uncommon for an ObGyn patient to be covered on a spouse’s or family insurance plan. Ensure that the policyholder’s information matches the patient’s details. This step is crucial to prevent potential billing errors and avoid delay of care at critical times.
  • Check Coverage Dates. The start and end dates of the insurance coverage should always be verified. Mid-year changes in plans or updates in deductibles can affect overall eligibility and are often overlooked. One reliable way to provide patient eligibility verification in ObGyn offices is through a billing partner’s online verification system.
  • Determine Coverage Details. Understand the scope of coverage, including deductibles, limits, copayments, and coinsurance. This verification stage ensures accurate billing of an insurance plan. Equally as important is the invoicing of a patient’s financial responsibility. Getting it right demonstrates to your patients that their peace of mind is a priority to your office.

A Smooth Delivery of New York ObGyn Services

Much depends on the accurate and timely provision of ObGyn services. By optimizing the patient eligibility verification process, practice administrators can ensure a streamlined revenue management process while focusing on efficient patient-centered care.

  • Verify Referrals or Authorizations. If the patient’s insurance requires complex referrals or prior authorizations for specific services, supplies, or procedures, ensure that these have been obtained before the scheduled appointment. This applies to commercial, federal, and state insurance coverage.
  • Check In-Network Status. Healthcare networks are constantly changing. To ensure uninterrupted and smooth delivery of medical services, regularly check to determine if your New York ObGyn practice is in network with the patient’s insurance plan. In-network providers usually offer lower out-of-pocket costs and minimize deductibles for patients.
  • Identify Special Requirements. Some insurance plans have specific requirements or additional deductibles that could risk authorization delays or claim denials. For example, a more complicated test or procedure may require a physician first to provide a minimally invasive treatment. It is not uncommon for repeated or supportive testing to require prior authorization. Establishing a process, whether it is in-house or outsourced, provides a thorough understanding of the patient’s coverage requirements.
  • Document the Verification Process. No medical record is complete without detailed records of the verification process. This documentation is crucial for resolving disputes or claim issues. Include in medical records the date and time of verification and the method, such as IVR or online search. If a phone call is made to verify eligibility, also record the representative’s name and time. Finally, detail the information provided. These steps take time but are invaluable to a smooth claims process and complete care for each patient.
  • Provide Patient Education. Patients are their own best advocates. By embracing a comprehensive verification process, ObGyn practices are putting their patients first. The information obtained helps communicate the care process and a patient’s financial responsibilities and obligations before the appointment. Setting expectations leads to a smooth delivery of services.


In New York, healthcare regulations and insurance dynamics are intricate. That is why a well-executed process for patient eligibility verification in ObGyn offices is essential to navigate the complexities of healthcare reimbursement without diminishing patient care. Whether it involves internal procedures or is outsourced to a billing service like StarkBilling, a well-honed system mitigates administrative errors, enhances cash flow, and contributes to the overall financial health of the practice.

Take your ObGyn practice and financial health to new heights with the help of a New York specialized medical billing partner who delivers reliable, responsive, and timely quality work. Contact StarkBilling today.