Changing policies. New forms. Added steps to the process. Pick any one of these, yet alone the longer laundry list of the issues related to eligibility reporting, and it’s understandable why many practices have a problem with staying current and optimizing the various tools offered to them. I correlate it to taxes – tax accountants are paid to stay current with everything and so increase the return to each customer.
The same can probably be said for medicare eligibility verification. There are specialists it is possible to outsource to, ultimately optimizing the process for the practice. For people who maintain the eligibility in-house, don’t overlook proven methods. Adhere to these pointers to assist guarantee get it right every time and lower the potential risk of insurance claim issues and improve your revenue.
Top Five Overlooked Methods Proven to Raise the Efficiency, Accuracy of Eligibility Verification.
1) Verifying existing and new patient eligibility each and every visit: New and existing patients must have their eligibility verified Every. Single. Visit. Frequently, practices usually do not re-verify existing patient information because it’s assumed their qualifying information will stay the same. Not the case. Change of employment, change of insurance policy coverage or company, services and maximum benefits met can alter eligibility.
2) Assuring accurate and finished patient information: Mistakes can be made in data entry when someone is wanting to become speedy for the sake of efficiency. Including the slightest inaccuracy in patient information submitted for eligibility verification may cause a domino effect of issues. Triple checking the accuracy of your own eligibility entries will appear to be it wastes time, nevertheless it will save time in the end saving practice managers from unnecessary insurance provider calls and follow-up. Ensure that you hold the patient’s name spelling, birth date, policy number and relationship for the insured correct (just to name a few).
3) Choosing wisely when depending on clearing houses: While clearing houses can provide quick access to eligibility information, they normally usually do not offer all information you need to accurately verify a patient’s eligibility. More often than not, a call created to a representative at an insurance carrier is essential to assemble all needed eligibility information.
4) Knowing exactly what a patient owes before they even reach the appointment: You have to know and anticipate to advise an individual on the exact amount they owe to get a visit before they even can arrive at the office. This will save money and time to get a practice, freeing staff from lengthy billing processes, accounts receivable follow-up and even enlisting the help of cgigcm bureaus to gather on balances owed.
5) Having a verification template specific towards the office’s/physician’s specialty. Defined and particular questions for coverage regarding your specialty of practice will be a major help. Not every specialties are the same, nor are they treated the identical by insurance carrier requirements and coverage for claims and billing.
Since we said, it’s practically impossible for those practice operations to perform smoothly. There are inevitable pitfalls and areas susceptible to issues. It is important to establish a defined workflow plan that includes mixture of technology and outsourcing if needed to attain consistency and accountability.
We are a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments. We offer Eligibility Verification for preventing insurance claim denials. Our service begins with retrieving a summary of scheduled appointments and verifying insurance coverage for the patients. Once the verification is carried out the coverage facts are put into the appointment scheduler for the office staff’s notification.
