The healthcare landscape is different, 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 gather the revenue they are entitled.
In fact, practices are generating up to 30 to 40 percent of their revenue from patients who may have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact cashflow and profitability.
One option is to boost eligibility checking making use of 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 rehearse management solutions.
Check out patient eligibility on payer websites. Call payers to determine eligibility for further complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered when they occur in an office or diagnostic centre. Clearinghouses tend not to 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 with regards to their financial responsibilities before service delivery, educating them about how much they’ll need to pay and when.Determine co-pays and collect before service delivery. Yet, even if accomplishing this, there are still potential pitfalls, like alterations in eligibility because of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all this looks like lots of work, it’s because it is. This isn’t to state that practice managers/administrators are unable to do their jobs. It’s that sometimes they need some assistance and tools. However, not performing these tasks can increase denials, along with impact cashflow and profitability.
Eligibility checking is definitely the single most effective way of preventing insurance claim denials. Our service starts off with retrieving a summary of scheduled appointments and verifying insurance policy coverage for that patients. After the verification is done the coverage facts are put into the appointment scheduler for your office staff’s notification.
You can find three methods for checking eligibility: Online – Using various Insurance carrier websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance companies directly an interactive voice response system will provide the eligibility status. Insurance Carrier Representative Call- If required calling an Insurance company representative will provide us a much more detailed benefits summary for several 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 might be right for practices to outsource their eligibility checking for an experienced firm.
To prevent insurance claims denials Eligibility checking will be the single best approach. Service shall start with retrieving listing of scheduled appointments and verifying insurance coverage for your patient. After dmcggn verification is done, data is put into appointment scheduler for notification to office staff.
For outsourcing practices must check if the subsequent measures are taken as much as check eligibility:
Online: Check patient’s coverage using different Insurance company 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 company Automated call: Obtaining summary for certain payers by calling an Insurance Provider representative when enough details are not gathered from website
Inform Us About Your Experiences – What are some of the EHR/PM limitations that your practice has experienced when it comes to eligibility checking? How often does your practice make calls to payer organizations for eligibility checking? Tell me by replying inside the comments section.