The healthcare landscape has changed, and one of the primary changes is the growing financial responsibility of patients with high deductibles which require them to pay physician practices for services. This is an area where practices are struggling to collect the revenue they are entitled.
In fact, practices are generating up to 30 to forty percent of the revenue from patients who may have high-deductible insurance policy. Failing to check patient eligibility and deductibles can increase denials, negatively impact cashflow and profitability.
One solution is to enhance eligibility checking utilizing the following best practices: Check patient eligibility 48 to 72 hours prior to scheduled visit using one of those three methods: Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and rehearse management solutions.
Look up patient eligibility on payer websites. Call payers to determine eligibility for additional complex scenarios, including coverage of particular procedures and services, determining calendar year maximum coverage, or if perhaps services are covered should they occur in a business office or diagnostic centre. Clearinghouses usually do not provide these details, so calling the payer is important for these scenarios.
Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients with regards to their financial responsibilities before service delivery, educating them on how much they’ll need to pay so when.Determine co-pays and collect before service delivery. Yet, even when accomplishing this, you may still find potential pitfalls, such as alterations in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this seems like a lot of work, it’s as it is. This isn’t to state that practice managers/administrators are not able to do their jobs. It’s just that sometimes they need some assistance and better tools. However, not performing these tasks can increase denials, in addition to impact income and profitability.
Eligibility checking is definitely the single most effective way of preventing insurance claim denials. Our service begins with retrieving a listing of scheduled appointments and verifying insurance coverage for your patients. After the verification is carried out the policy data is put into the appointment scheduler for the office staff’s notification.
There are three options for checking eligibility: Online – Using various Insurance provider websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance firms directly an interactive voice response system will give the eligibility status. Insurance Provider Representative Call- If needed calling an Insurance provider representative will provide us a much more detailed benefits summary for certain payers if not provided by either websites or Automated phone systems.
Many practices, however, do not have the time to complete these calls to payers. In these situations, it may be right for practices to outsource their eligibility checking with an experienced firm.
For preventing insurance claims denials Eligibility checking is the single most effective way. Service shall begin with retrieving set of scheduled appointments and verifying insurance coverage for the patient. After dmcggn verification is finished, data is put in appointment scheduler for notification to office staff.
For outsourcing practices must find out if the subsequent measures are taken approximately check eligibility:
Online: Check patient’s coverage using different Insurance carrier websites and internet payer portal.
Automated Voice System (IVR): Acquiring eligibility status by calling Insurance providers directly and interactive voice response system will answer.
Insurance carrier Automated call: Obtaining summary for several payers by calling an Insurance Provider representative when enough information is not gathered from website
Tell Us About Your Experiences – What are among the EHR/PM limitations that your particular practice has experienced when it comes to eligibility checking? How frequently does your practice make calls to payer organizations for eligibility checking? Tell me by replying in the comments section.