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Sample lesson · Front office · 18 min

Real-Time Eligibility — running it right.

The most leveraged 90 seconds of your day. Run RTE the right way and the practice gets paid, the patient knows what they owe, and the billing department doesn't inherit a problem next month. Run it the wrong way and you've created a denial.

Format · Audio + 5 chapters
Outcome · Run RTE on any patient and explain the response
Difficulty · Beginner
Estimated time · 18 minutes
Now playing — Lesson narration 02:34 / 11:48

Eligibility isn't paperwork. Eligibility is the moment the entire revenue cycle either starts clean or starts broken. And ninety seconds at the front desk decides which.

Chapter 3 · Step 2 of 4 Pattern recognition · interactive

Three RTE responses you'll see today.

RTE responses come in three flavors: clean, complicated, and broken. Below are realistic examples of each. The skill is recognizing which is which in three seconds and knowing what to do next.

01

The clean one — green light, move on.

Maria, 67, Medicare + AARP. The most common response you'll see in a primary care clinic. Active. Effective date well in the past. Copay covered by supplement. Move her along.

✓
Maria Flores · Medicare Part B
270/271 · 4.2s
StatusActive · benefits in effect
Effective from04/01/2018
Plan typeOriginal Medicare
Copay (PCP)$0 — supplement covers
Deductible YTD$257 / $257 met
NotesAnnual wellness eligible · covered 100%

What you do: Confirm copay $0, mark her arrived, move on. Total 60 seconds.

02

The complicated one — read it carefully.

Patricia, 41, Anthem HDHP. This is where most front-office MAs miss things. The status is active — but the copay is $0 because the plan is high-deductible and she hasn't met any of her deductible yet. Today's visit will hit her for the contracted rate.

!
Patricia Romero · Anthem HDHP
270/271 · 5.1s
StatusActive · benefits in effect
Effective from01/01/2026
Plan typeHDHP — high deductible
Copay (PCP)$0 (deductible applies)
Deductible$0 / $4,200 met YTD
Coinsurance after ded.20%
Estimated visit cost$340–$420 patient responsibility

What you do: Don't let her sit down without telling her. The conversation we'll cover in Chapter 5 starts with: "Patricia, your plan has a high deductible — let me walk you through what that means for today."

03

The broken one — the most important to recognize.

David, 34, says he switched jobs in March and his old Aetna card is on file. Run RTE on the file you have, and you get this:

×
David Kim · Aetna PPO (on file)
270/271 · 3.8s
StatusInactive · coverage terminated
Termination date02/29/2026
ReasonMember no longer eligible — group canceled
Recommended actionVerify current insurance with member

What you do: Stop. Do not check him in. Do not run him through. Ask him for his current card. Update Coverage in Prelude. Re-run RTE on the new plan. Then proceed.

"
What to say to the patient

"David, our system shows your Aetna ended in February — it looks like that was tied to your old job. Do you have your current insurance card with you? I'll get it updated right now so we don't bill the wrong plan."

04

The pattern.

Three colors. Green: keep moving. Yellow: stop and explain. Red: stop and verify. Most front office MAs get the green right and the red right. The yellow is what separates a good front desk from a great one — because you can't undo a yellow once it walks past you.

Why this lesson exists

Eligibility errors are the #1 source of preventable denials.

Industry data: about 27% of denied claims trace back to a registration or eligibility issue at the front desk — wrong member ID, terminated coverage, missed secondary, wrong plan. Every one of those is a denial that the billing team has to chase 30–60 days later, often unsuccessfully.

Ninety seconds of attention here saves about $200 of work later. Across 28 patients a day, that's the financial spine of the practice.

Cheat sheet · downloadable

RTE traffic lights

GREEN — go
  Active + effective ≥ 6mo
  Copay clear
  No deductible flag

YELLOW — explain
  HDHP / high deductible
  Plan changed mid-year
  Out-of-network warning
  Auth required for visit

RED — stop
  Inactive / termed
  Member ID not found
  Wrong subscriber
  Payer system down

Always re-run RTE
after any coverage edit.
Pause & try · cohort exercise

Run RTE three times tomorrow morning.

Look at each response. Categorize each one — green, yellow, or red. Post which colors you saw and how many of each in the cohort thread. Bonus: the script you used on a yellow.