Correct information is Key:
Providing correct information to the patient is important; quoting correct benefits, patient responsibility and scheduling conflicts are common issues.
Recommendations on Obtaining Information From Patients:
Get Proper Address Confirmation:
Word as: “Please provide your address”; instead of asking if there are any changes to their address.
Get Proper Insurance Confirmation:
Word as: “Please provide your current insurance”; instead of asking if there are any changes to their insurance.
Telephone Number Confirmation:
Word as: “Please provide your telephone number”; instead of asking if there are any changes to their phone numbers.
Check for Other Insurance:
If only provided one insurance carrier, ask if the patient has a secondary carrier.
Contracted Insurance Carriers
The practice should have a document that is shared with all office staff on who the contracted insurance carriers are that they participate with. If there is a plan that is out of network the patient should sign a financial policy acknowledging they are aware the benefits will be processed out of network.
Verify Eligibility – Medicaid
Utilize the software to perform electronic eligibility status; if unable use the insurance carriers’ website and if that fails call the carrier directly. Verify at least once a month.
Verify Eligibility – W/C Carriers
Have patient provide all information pertaining to the case by filling out the demographic form to include insurance carrier, insurance carrier address and telephone number, adjuster name, adjuster telephone and fax number, date of injury and approved diagnosis codes for the claim.
Verify Eligibility – All Other Carriers
Utilize the software to perform electronic eligibility status; if unable use the insurance carriers’ website and if that fails call the carrier directly. Verify at least once a month.
Insurance Cards:
Copies of both insurance cards (front and back) need to be scanned in. Please scan in all cards given by the patient, even if you think they might not pertain; including the patient’s driver license and/or ID.
New Documents:
Require new documents to be filled out, computer print outs the patient will just sign and not review the information. This should include the guarantor information if the patient is a child.
Referrals
A referral needs to be verified if required for each visit, if there is not a referral on file, reschedule the patient to a date after the referral can be provided.
Authorizations
The patient should not be seen for any type of service without confirmation if an authorization is required or not required. Reschedule the patient to a date after the authorization is received; if required.
Documentation:
Document all calls and/or conversations with the patient in a designated spot in the software. Review all alerts attached to the patient account.
Copayments, Deductibles and Coinsurance
Uncollected copayments,deductible and coinsurance amounts make up the majority of all reported collection balances.
Bad Debt or Collection Balances
Review account to see if previous bad debt adjustments or collection balances are owed. These balances should be collected prior to scheduling the appointment.
Balances
It should be explained to patients when they are paying for a date of service that they may have an additional responsibility. Remind them that the payment that is collected in the office is only an estimate and the true amount the patient will owe can only be determined after the claim processes.
