The healthcare landscape is different, and one of the biggest 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.
Actually, practices are generating as much as 30 to 40 percent of the revenue from patients who may have high-deductible insurance coverage. Neglecting to check patient eligibility and deductibles can increase denials, negatively impact cash flow and profitability.
One solution is to boost eligibility checking using the following best practices: Check patient eligibility 48 to 72 hours well before scheduled visit using one of these 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 find out eligibility for additional complex scenarios, like coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered should they occur in an office or diagnostic centre. Clearinghouses usually do not provide these details, so calling the payer is important 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 on how much they’ll have to pay and when.Determine co-pays and collect before service delivery. Yet, even though accomplishing this, you may still find potential pitfalls, such as modifications in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this looks like plenty of work, it’s since it is. This isn’t to express that practice managers/administrators are not able to do their jobs. It’s exactly that sometimes they want help and tools. However, not performing these tasks can increase denials, as well as impact cash flow and profitability.
Eligibility checking is the single best approach of preventing insurance claim denials. Our service starts with retrieving a list of scheduled appointments and verifying insurance coverage for your patients. When the verification is carried out the coverage facts are put directly into the appointment scheduler for your office staff’s notification.
You can find three options for checking eligibility: Online – Using various Insurance carrier websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance providers directly an interactive voice response system will give the eligibility status. Insurance Provider Representative Call- If required calling an Insurance provider representative will give us a more detailed benefits summary beyond doubt payers when not provided by either websites or Automated phone systems.
Many practices, however, do not have the time to finish these calls to payers. In these situations, it may be right for practices to outsource their eligibility checking for an experienced firm.
To prevent insurance claims denials Eligibility checking is definitely the single best approach. Service shall begin with retrieving list of scheduled appointments and verifying insurance policy coverage for the patient. After dmcggn verification is completed, facts are put into appointment scheduler for notification to office staff.
For outsourcing practices must see if these measures are taken up to 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 firms directly and interactive voice response system will answer.
Insurance provider Automated call: Obtaining summary for several payers by calling an Insurance Provider representative when enough information and facts are not gathered from website
Inform Us Regarding Your Experiences – What are the EHR/PM limitations that your particular practice has experienced with regards to eligibility checking? How often does your practice make calls to payer organizations for eligibility checking? Inform me by replying in the comments section.