The healthcare landscape has changed, and one of the primary 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 gather the revenue they are entitled.
Actually, practices are generating approximately 30 to forty percent of the revenue from patients who have high-deductible insurance coverage. Neglecting 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 in advance of 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 practice management solutions.
Search for patient eligibility on payer websites. Call payers to figure out eligibility for further 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 a business office or diagnostic centre. Clearinghouses do not provide these details, so calling the payer is necessary for such scenarios.
Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them regarding how much they’ll must pay and once.Determine co-pays and collect before service delivery. Yet, even though doing this, you may still find potential pitfalls, including modifications in eligibility as a result of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this looks like lots of work, it’s since it is. This isn’t to state that practice managers/administrators are unable to do their jobs. It’s that sometimes they require some help and better tools. However, not performing these tasks can increase denials, as well as impact cash flow and profitability.
Eligibility checking will be the single most effective way of preventing insurance claim denials. Our service starts with retrieving a summary of scheduled appointments and verifying insurance coverage for the patients. Once the verification is performed the policy facts are put directly into the appointment scheduler for your office staff’s notification.
You will find 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 provide the eligibility status. Insurance Company Representative Call- If required calling an Insurance carrier representative will give us a much more detailed benefits summary for several payers when they are not offered by either websites or Automated phone systems.
Many practices, however, do not have the resources to finish these calls to payers. During these situations, it might be suitable for practices to outsource their eligibility checking for an experienced firm.
To prevent insurance claims denials Eligibility checking is the single most effective way. Service shall start out with retrieving list of scheduled appointments and verifying insurance policy for the patient. After dmcggn verification is done, details are placed into appointment scheduler for notification to office staff.
For outsourcing practices must check if these measures are taken as much as 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 company Automated call: Obtaining summary for certain payers by calling an Insurance Company representative when enough information is not gathered from website
Tell Us About Your Experiences – What are the EHR/PM limitations that your practice has experienced with regards to eligibility checking? How often does your practice make calls to payer organizations for eligibility checking? Tell me by replying inside the comments section.