The healthcare landscape has changed, and one of the biggest changes is the growing financial responsibility of patients with high deductibles that require them to pay physician practices for services. This is an area where practices are struggling to collect the revenue they are entitled.
Actually, practices are generating as much as 30 to 40 % of their revenue from patients who have high-deductible insurance policy. Failing to check patient eligibility and deductibles can increase denials, negatively impact cashflow and profitability.
One option is to improve eligibility checking utilizing the following best practices: Check patient eligibility 48 to 72 hours well before scheduled visit using one of these 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 practice management solutions.
Check out patient eligibility on payer websites. Call payers to figure out eligibility for more complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if perhaps services are covered should they occur in an office or diagnostic centre. Clearinghouses tend not to provide these details, so calling the payer is essential for these particular 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 regarding how much they’ll need to pay and when.Determine co-pays and collect before service delivery. Yet, even when accomplishing this, you may still find potential pitfalls, including changes in eligibility as a result of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If this all seems like a lot of work, it’s because it is. This isn’t to say that practice managers/administrators are unable to do their jobs. It’s that sometimes they need some help and better tools. However, not performing these tasks can increase denials, as well as impact cash flow and profitability.
Eligibility checking is the single most effective way of preventing insurance claim denials. Our service starts with retrieving a list of scheduled appointments and verifying insurance policy for your patients. Once the verification is carried out the policy data is put into the appointment scheduler for your office staff’s notification.
You can find three methods for checking eligibility: Online – Using various Insurance carrier websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance providers directly an interactive voice response system will provide the eligibility status. Insurance Company Representative Call- If necessary calling an Insurance carrier representative will provide us a more detailed benefits summary for certain payers when they are not available from either websites or Automated phone systems.
Many practices, however, do not have the resources to finish these calls to payers. In these situations, it may be right for practices to outsource their eligibility checking for an experienced firm.
For preventing insurance claims denials Eligibility checking is the single best approach. Service shall start out with retrieving set of scheduled appointments and verifying insurance policy for that patient. After dmcggn verification is finished, facts are put in appointment scheduler for notification to office staff.
For outsourcing practices must check if these measures are taken approximately check eligibility:
Online: Check patient’s coverage using different Insurance company websites and internet payer portal.
Automated Voice System (IVR): Acquiring eligibility status by calling Insurance firms directly and interactive voice response system will answer.
Insurance carrier Automated call: Obtaining summary for certain payers by calling an Insurance Carrier representative when enough details are not gathered from website
Tell Us Concerning Your Experiences – What are the EHR/PM limitations that your practice has experienced when it comes to eligibility checking? How many times does your practice make calls to payer organizations for eligibility checking? Let me know by replying within the comments section.