Gastroenterology Coding Alert

Question: A patient came to our office with the same insurance card she’s had for years. We charged her the standard co-pay of record. Then I found out her employer changed the terms of the insurance, so the co-pay she paid was not correct and she had paid us less than stipulated. What went wrong?

Wisconsin Subscriber

Answer: You might easily assume that when a patient has the same insurance company, the co-pay is the same as it has always been. But unless you check first, you won’t know the patient’s coverage has changed until after the fact.

Best practice: Set up a process to verify each patient’s insurance information before every visit. The ideal time to verify with a patient or her insurance company is either before the appointment or when she arrives at your office. Devise a plan for how you will obtain patient information early on.

Your options include connecting with the patient, a software program, or through the payer directly.

Finally, copy every patient’s insurance card every time. This simple step will put you in the clear for those times when a patient’s terms, copays, or precertification contact numbers have changed.