EPISODE SUMMARY
Is your practice tired of wrestling with insurance denials? In this episode, Jeremy Zug flies solo to dive into the crucial third stage of the Revenue Cycle Management (RCM) Game Board: Eligibility and Benefits (E&B). Jeremy breaks down a two-step, methodical strategy designed to drastically cut down your denial rate and eliminate costly billing surprises. Learn why checking E&B is like reading a rule book before a major journey , and discover the key information to collect to ensure you get paid for the incredible value you add. It’s time to stop walking blind into more denials and start winning The Claim Game
KEYWORDS
Revenue Cycle Management (RCM), Eligibility and Benefits (E&B), Claim Denials, Prior Authorization, Payer Contacts, CPT Codes, Credentialing, Cash Flow, Practice Management, Practice Solutions, The Claim Game, Billing Surprises, Availity, Clean Claims, Documentation
TAKEAWAYS
We’re covering the two foundational steps to master the E&B territory: building your game manual and executing a consistent check.
1. Build Your Game Manual (The Centralized Cheat Sheet): Create a central, living database of essential payer-specific information.
Contact Information: Secure the direct, current phone numbers for provider relations—not the general patient line. Note the most efficient route for E&B details, whether a provider portal (like Availity) or a direct call.
Service List: Maintain a list of CPT codes for all services your practice provides to verify coverage for each patient’s specific plan.
Process Ownership: Assign a designated person to keep this "game manual" updated, ensuring the knowledge is tied to a repeatable process, not a single person's memory.
2. Make the E&B Check Mandatory (The Execution): This is the real-time verification that happens before the patient walks in. Every check must be identical and thorough, consolidated onto a standardized template.
Core Data: Collect and confirm the patient’s full name, date of birth, and subscriber ID—using objective sources like a copy of the insurance card (front and back) and driver’s license.
Required Checks: It's not just a yes/no active status. You need to confirm active coverage, provider match (NPI coverage) , CPT code coverage , telehealth coverage , and any prior authorization or referral requirements.
Document Everything: To have "fighting power" against incorrect denials, always secure a date, the payer rep name (if you called), and a reference number for every verification call. This paper trail is your best defense.
CHAPTERS
00:00 Introduction: Your Two-Step Strategy to Cut Denials
02:55 Creating Your Payer Playbook: Contacts, Codes & Clear Ownership
07:36 The Payoff: How E&B Checks Keep Your Claims Alive
09:01 The E&B Checklist: Verifying Coverage Before the First Session
12:02 The E&B Defense Strategy: What Happens When You Don’t Get It Right
15:37 Case Study: When Missing Steps Cost Thousands
18:09 Conclusion: The Foundations for a Strong, Repeatable E&B Process
RESOURCES
Today Sponsors: Blueprint
Learn More About The Claim Game: Visitpracticesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitingThe Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management atPractice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Images: Eligibility & Benefit Check Template, Insurance Contact Reference List
