The healthcare landscape has changed, and one of the primary changes is the growing financial responsibility of patients with high deductibles which require them to pay physician practices for services. This is an area where practices are struggling to accumulate the revenue they are entitled.
In reality, practices are generating up to 30 to 40 percent of the revenue from patients who have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact income 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 more complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered should they occur in a workplace or diagnostic centre. Clearinghouses usually do not provide these details, so calling the payer is important 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 regarding how much they’ll need to pay and once.Determine co-pays and collect before service delivery. Yet, even though doing this, you can still find potential pitfalls, including changes in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this seems like lots of work, it’s as it is. This isn’t to express that practice managers/administrators are unable to do their jobs. It’s just that sometimes they want some assistance and much better tools. However, not performing these tasks can increase denials, in addition to impact income and profitability.
Eligibility checking is definitely the single best approach of preventing insurance claim denials. Our service starts off with retrieving a list of scheduled appointments and verifying insurance coverage for that patients. After the verification is carried out the policy details are put into the appointment scheduler for that office staff’s notification.
There are three techniques for checking eligibility: Online – Using various Insurance company websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance firms directly an interactive voice response system will give the eligibility status. Insurance Provider Representative Call- If needed calling an Insurance company representative will provide us a far more detailed benefits summary for certain payers if not offered by either websites or Automated phone systems.
Many practices, however, do not have the resources to accomplish these calls to payers. During these situations, it might be right for practices to outsource their eligibility checking with an experienced firm.
To prevent insurance claims denials Eligibility checking is definitely the single most effective way. Service shall start out with retrieving list of scheduled appointments and verifying insurance policy coverage for that patient. After dmcggn verification is done, details are put in 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 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 certain payers by calling an Insurance Provider representative when enough information and facts are not gathered from website
Inform Us About Your Experiences – What are the EHR/PM limitations that the practice has experienced with regards to eligibility checking? How many times does your practice make calls to payer organizations for eligibility checking? Inform me by replying within the comments section.