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 collect the revenue they are entitled.
Actually, practices are generating as much as 30 to 40 % 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 would be 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 brilliant 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 exercise management solutions.
Search for patient eligibility on payer websites. Call payers to find out eligibility for more complex scenarios, including coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered when they take place in a workplace or diagnostic centre. Clearinghouses tend not to provide these details, so calling the payer is essential for these scenarios.
Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients regarding 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 if doing this, you may still find potential pitfalls, such as changes in eligibility as a result of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If this all seems like plenty of work, it’s since 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 cashflow and profitability.
Eligibility checking will be the single best way of preventing insurance claim denials. Our service starts off with retrieving a list of scheduled appointments and verifying insurance policy coverage for that patients. After the verification is done the policy details are put directly 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 providers directly an interactive voice response system can give the eligibility status. Insurance Company Representative Call- If necessary calling an Insurance provider representative can give us a more detailed benefits summary beyond doubt payers when they are not provided by either websites or Automated phone systems.
Many practices, however, do not possess the resources to accomplish these calls to payers. During these situations, it may be suitable for practices to outsource their eligibility checking to an experienced firm.
To prevent insurance claims denials Eligibility checking is the single best approach. Service shall start out with retrieving list of scheduled appointments and verifying insurance policy for the patient. After dmcggn verification is done, facts are put into appointment scheduler for notification to office staff.
For outsourcing practices must see if the subsequent measures are taken as much as 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 companies 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 Regarding Your Experiences – What are among the EHR/PM limitations that the 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 in the comments section.