The healthcare landscape has changed, and one of the greatest changes is the growing financial responsibility of patients with high deductibles that need them to pay physician practices for services. This is an area where practices are struggling to accumulate the revenue they are entitled.
In fact, practices are generating up to 30 to 40 % with their revenue from patients that have high-deductible insurance policy. Neglecting to check patient eligibility and deductibles can increase denials, negatively impact cashflow and profitability.
One solution is to enhance eligibility checking making use of the following best practices: Check patient eligibility 48 to 72 hours prior to scheduled visit using one of these brilliant 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 exercise management solutions.
Look up patient eligibility on payer websites. Call payers to figure out eligibility for more complex scenarios, like coverage of particular procedures and services, determining calendar year maximum coverage, or maybe services are covered should they take place in an office or diagnostic centre. Clearinghouses do not provide these details, so calling the payer is necessary for these particular scenarios.
Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them about how much they’ll need to pay and once.Determine co-pays and collect before service delivery. Yet, even when carrying this out, there are still potential pitfalls, such as modifications in eligibility as a result of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all this looks like lots 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 want help and better tools. However, not performing these tasks can increase denials, as well as impact cashflow and profitability.
Eligibility checking is definitely the single best way of preventing insurance claim denials. Our service begins with retrieving a list of scheduled appointments and verifying insurance policy coverage for your patients. Once the verification is done the coverage facts are put straight into the appointment scheduler for your office staff’s notification.
There are three options for checking eligibility: Online – Using various Insurance company 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 Carrier Representative Call- If necessary calling an Insurance provider representative will provide us a much more detailed benefits summary for several payers when not available from either websites or Automated phone systems.
Many practices, however, do not have the time to accomplish these calls to payers. During these situations, it may be suitable for practices to outsource their eligibility checking to an experienced firm.
To prevent insurance claims denials Eligibility checking is definitely the single most effective way. Service shall start with retrieving list of scheduled appointments and verifying insurance policy for that patient. After dmcggn verification is finished, data is placed into appointment scheduler for notification to office staff.
For outsourcing practices must see if the following measures are taken up to 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 providers directly and interactive voice response system will answer.
Insurance carrier Automated call: Obtaining summary beyond doubt payers by calling an Insurance Carrier representative when enough details are not gathered from website
Inform Us Concerning Your Experiences – What are the EHR/PM limitations that your particular practice has experienced in terms of eligibility checking? How often does your practice make calls to payer organizations for eligibility checking? Inform me by replying inside the comments section.