Win The Losing Battle-Verify

August 5th, 2014 - Donna Weinstock
Categories:   Collections   Insurance   Reimbursement  
0 Votes - Sign in to vote or comment.

           

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)

Delving Into the 360 Assessment Fraud Complaint
November 17th, 2021 - Jessica Hocker, CPC, CPB
The Department of Justice is pursuing claims of healthcare fraud against Cigna Health-Spring Medicare Advantage plan based on how they used data from their 360 Program in 2012. A review of the allegations may help other payers avoid similar accusations.
Lessons Learned from a RADV Audit Report
November 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
If given an opportunity to know ahead of time the questions that would be asked of you in an upcoming interview or quiz, it is likely the outcome would be significantly better than if you were surprised by the questions. This same concept may be applied to audits of risk ...
Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022
November 11th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time ...
Reporting and Auditing Drug Testing Services
November 9th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT
Drug testing is a common medical service used to manage prescription medications, verify someone is not taking illegal substances or too much of a prescribed substance, and monitor for toxicity and therapeutic dosing. It is customary for patients in treatment programs for chronic pain management or substance use disorders (SUD) to undergo random urine drug testing (UDT) or urine drug screening (UDS) as part of their individual treatment plan. Drug testing is regulated by federal and state laws (e.g., OSHA, CLIA), which must be carefully adhered to.
Understanding ASCs and APCs: Indicators and Place of Service
October 28th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...
Are You Keeping up with the Official ICD-10-CM Guideline Changes for COVID-19?
October 25th, 2021 - Wyn Staheli, Director of Research
The COVID-19 public health emergency (PHE) has made it interesting and challenging for organizations to keep an eye on the evolving changes to the ICD-10-CM Official Guidelines for Coding and Reporting. Have you been keeping up with these changes?
Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?
October 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association