The healthcare landscape has evolved, 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 collect the revenue they are entitled.
Actually, practices are generating up to 30 to 40 percent of their revenue from patients that have high-deductible insurance policy coverage. Neglecting to check patient eligibility and deductibles can increase denials, negatively impact cash flow and profitability.
One solution is to enhance eligibility checking making use of the following best practices: Check patient eligibility 48 to 72 hours in advance of 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.
Search for patient eligibility on payer websites. Call payers to find out eligibility for further complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if perhaps services are covered when they take place in an office or diagnostic centre. Clearinghouses tend not to 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 regarding their financial responsibilities before service delivery, educating them about how much they’ll must pay and when.Determine co-pays and collect before service delivery. Yet, even if doing this, you can still find potential pitfalls, including changes in eligibility as a result of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this sounds like lots of work, it’s because it is. This isn’t to say that practice managers/administrators are not able to do their jobs. It’s just that sometimes they need some help and tools. However, not performing these tasks can increase denials, along with impact income and profitability.
Eligibility checking is definitely the single best way of preventing insurance claim denials. Our service starts with retrieving a list of scheduled appointments and verifying insurance coverage for your patients. Once the verification is carried out the policy data is put straight into the appointment scheduler for that office staff’s notification.
There are 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 firms directly an interactive voice response system can give the eligibility status. Insurance Company Representative Call- If required calling an Insurance provider representative will give us a more detailed benefits summary beyond doubt payers if not provided by either websites or Automated phone systems.
Many practices, however, do not possess the time to complete these calls to payers. Within these situations, it might be right for practices to outsource their eligibility checking for an experienced firm.
For preventing insurance claims denials Eligibility checking is definitely the single best way. Service shall start with retrieving set of scheduled appointments and verifying insurance policy coverage for your patient. After dmcggn verification is done, facts are put in appointment scheduler for notification to office staff.
For outsourcing practices must find out if these measures are taken approximately 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 providers directly and interactive voice response system will answer.
Insurance provider Automated call: Obtaining summary for certain payers by calling an Insurance Carrier representative when enough information is not gathered from website
Tell Us About Your Experiences – What are the EHR/PM limitations that your particular practice has experienced in terms of eligibility checking? How many times does your practice make calls to payer organizations for eligibility checking? Tell me by replying in the comments section.