Verify Medical Insurance – Especially if Your Practice is in a College Town

Verify Medical Insurance – Especially if Your Practice is in a College Town

By Janice Jacobs, CPC, CPCO

As if managing your patients’ insurance information and benefits isn’t hard enough, being a provider in a college town adds to the challenges and difficulty in getting timely reimbursement. The typical student spends at least four years at a college or university; however, they may live at four or more different addresses during that time, starting with the college dormitory and then moving to off campus housing. Many students are covered under their parents’ insurance, who live in a different state. Sometimes the student permanently lives with one parent, but is covered under the insurance of another parent who lives at a different address. You can see why it is very important not only to verify the patient’s current address but also their permanent home address and the address of the guarantor of the policy. One or more of these could very possibly have changed since the patient’s last visit.

To add to the confusion, due to the rising cost of healthcare coverage in the United States, insurance companies are raising their rates annually, forcing companies to shop around more frequently. When I started working many years ago, I had the same insurance coverage for the duration of my employment. Now my insurance changes almost annually in order for my employer to be able to provide the best coverage possible at a cost that is reasonable. I have sent my son, who attends college in another state, three new sets of insurance cards over the past four years. I noticed with interest that he is never asked about whether his insurance changed upon signing in for a doctor or emergency visit. Thinking about whether Mom is still on Aetna or did she move to Blue Cross/Blue Shield isn’t at the forefront of his mind when he is standing there with a broken hand or running a high fever.

One would think that it would be a fairly easy fix for the guarantor to call after the fact and provide the updated information, but that is not always the case. With HIPAA privacy regulations, information regarding anyone over 18 is confidential, even to the parents who are the responsible parties for the bills. I remember trying to provide only insurance and payment information for my son’s account and it was very difficult. Technically, this should not have been a problem, but office staff is not always educated on exactly what they can and cannot do regarding adult children who are covered under parent policies. All of these factors will delay payment of an otherwise clean claim.

Checking eligibility and coverage up front takes far less time and effort than trying to resolve a denied claim after the fact. Patients (or their parents) receive incorrect bills, resulting in follow-up phone calls and wasted time waiting in a queue to speak to an insurance company representative or to a busy practice manager.  When considering the complexity of submitting a claim, the importance of identifying the correct payer at the point of service seems like a no-brainer.  It is a small inconvenience for the patient at check-in to provide an insurance card.  I have been guilty, myself, of not remembering which provider has my new insurance information, and I appreciate the reminder from the front desk personnel.  If I were a practice manager in a college town, there would be a zero tolerance for not verifying and updating insurance information.  It just makes good business sense.  And in addition to improved customer service, it improves cash flow for the practice and reduces administrative hours spent in resolving denied claims.

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Janice Jacobs

Janice Jacobs

Janice G. Jacobs, CPC, CPCO, is a Director at IMA Consulting in their Compliance and Coding Practice. Janice has over 25 years of healthcare industry experience including hospital accounting and auditing, inpatient, outpatient and professional fee coding, compliance, and revenue cycle management. Janice frequently advises large physician practices on various coding and compliance issues.
Janice Jacobs

About Has 5 Posts

Janice G. Jacobs, CPC, CPCO, is a Director at IMA Consulting in their Compliance and Coding Practice. Janice has over 25 years of healthcare industry experience including hospital accounting and auditing, inpatient, outpatient and professional fee coding, compliance, and revenue cycle management. Janice frequently advises large physician practices on various coding and compliance issues.

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