Win The Losing Battle-Verify

August 5th, 2014 - Donna Weinstock

Categories: Collections Insurance Reimbursement

Do you feel like you are fighting a losing battle? Are you watching your account receivables going up and your collections going down? Is your cash flow suffering? What is a practice to do?

One of the most effective ways to keep your cash flowing is by checking your patient’s benefits before the patient arrives for their appointment. It is so easy to say that there isn’t time to verify benefits for every office visit, but the truth is “knowledge is power.” Knowing whether your patient’s benefits are active can help you collect at the time of service. Starting your collection process on the front end saves time on the back end. Face to face is always the best way to collect money from patients, therefore knowing what a patient will owe prior to the visit is beneficial.

With the varying policies, deductibles sky rocketing and insurance coverage changing often, a practice often find themselves without reimbursement when the claim is finally processed. Too often you see “no coverage for the person.” It may be that the patient left his job and did not keep his insurance, or it may be that the group changed and the patient forgot to give you his new insurance card. Time is spent contacting the patient only to find out that a claim needs to be re-billed or reprocessed. Had you known ahead of time, the claim may have been paid the first time it was submitted.

If your practice does not already do so, look into verifying eligibility, benefits and coverage on-line. Your electronic health record may have a feature to check benefits directly through their system. If not, contact your clearing house and/or insurance carriers to learn the easiest way to do electronic verifications.

Finding out the patient has no coverage allows you to collect payment at the time services are rendered. A patient may say they don’t have their check book or credit card with them; be ready to give them a statement at that time. Timely statements allows for faster collection of money owed.

Verifying insurance coverage prior to a surgery allows the practice to not only know if the patient is covered, but if the procedure is covered within the policy guidelines. Certain policies have limits on coverage and medically necessity. For this reason, it is important to know if the surgery requires precertification. Without the proper documentation, coverage will be denied.

Consider keeping credit cards on file. This can be tricky as you will need to verify that the numbers are secure. Whether you set up a system in your office or hire an outside credit card company to keep these credit cards, having them available allows you to charge the card with permission.

Have a financial policy that is specific to the expectation. Your policy should state when a payment is due by the patient or guarantor. Be specific if you want to charge small balances following insurance processing without billing patients. Have a place for the patient/guarantor to sign the financial policy. Keep the original and give the patient a copy of the policy. This allows them to refer to it.

Depending on whether you are in or out of network with insurance companies, and how your contractual agreements are worded, a practice may be able to collect deductibles and coinsurances at the time of service or prior to the service in the case of a surgery. For this reason, knowing a patient’s benefits is important. This is especially beneficial for scheduled procedures or surgeries.

A patient with a high deductible may have trouble paying that deductible. When a practice is able to collect this upfront, it saves time and expense after the procedure has occurred. It is important to know how your contracts read to stay in compliance with the insurance companies.

Why not have practice policies to collect on auto accidents and certain types of litigation up front? More and more practices are adopting this method instead of filing a lien and waiting years to receive reimbursement.

Though time consuming, by verifying benefits your practice has the potential to save time and money. You are prepared and able to address the finances with the patient prior to the office visit or procedure. It allows for easier collection of money due to the practice. Collection at the time of service will decrease your accounts receivable simply by not adding to it.

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox

When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.

Accurately Reporting Signs and Symptoms with ICD-10-CM Codes
October 5th, 2023 - Aimee Wilcox

Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.

The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance
September 19th, 2023 - Aimee Wilcox

Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.

Documenting and Reporting Postoperative Visits
September 12th, 2023 - Aimee Wilcox

Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?

Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding
August 22nd, 2023 - Aimee Wilcox

Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.