Wiki Insurance Verifications

[sglamuzina]

We are a small practice with 7 providers and accept MOST PPO's, Medicare and have contracts with Multiple Medical Groups. Does any one have any recommendations for Insurance Verifications. Currently, it is handled by our Billing Dept. but I am trying to see what other practices do.

Thank you,
~Stephanie Glamuzina-Bryan

 

[csperoni]

With the capabilities of most EHR systems, the system itself can usually do the actual verification itself. My personal opinion is that if ANYTHING is off, that should be reviewed by a biller. Unless your front desk are very experienced and detail oriented, they usually do not have enough training or experience to understand how much impact what seems to them like a minor thing can result in denied claim and the headache that causes down the road.
In my healthcare organization, in most practices the entire responsibility falls on the front desk. In my particular practice (at my insistence), the front desk is responsible to click the button to verify, and unless everything is a match, that falls to a worklist that my biller reviews.
If for some reason, you have humans (front desk or billers) doing a lot of actual verifications (website or phone), you may want to check with your vendor about additional capabilities.
Regarding how often a verification is done, my personal recommendation is at least every 60 days. I've worked places with timeframes of only good for 7 days, to only the first time each calendar year.

 

[TThivierge]

Hi Sglamuzina
At times it might be efficient to create an update Excel sheet with listing providers names, NPI with each assigned insurance payer ID or PIN for each provider and the specifics of what services cover. Then I d have another sheet or booklet with each major insurance carrier you deal with or in network listing each payers....., Pre auth phone number, fax # example of preauthorization form, online web address and phone numbers of benefits/verification dept. and their billing dept address, web site and phone #. I d have each front desk staff have one . Or can create Excel file with data for each to pull up in MS computer program. I do this data online in files in shared drive.However always have hard copy somewhere in office too. I hope this helps. Also get who talking to when do pre-authos and ensure dx codes match when bill for the patient.
I hope this data helps you. It will save time and funds and maybe denials but just have to update it
Lady T

 

[deepshikha]

"Does any one have any recommendations for Insurance Verifications. Currently"

Not sure if you are talking about Patient Eligibility to verify. If it is so, then most EDI clearinghouses providing EDI, ERA, and Eligibility capabilities as their regular services. Please contact to your EDI service providers what can do for you to assign this capability.

 

[amyjph]

I agree with Christine. It starts at the time of appointment scheduling and again before the patient comes in, and once again at the front desk. And, 100% it is rare to impossible to have front desk staff that will know and understand how one typo or one thing being off such as missing a middle initial can negatively impact the revenue cycle. Someone trained and with more experience should definitely review if anything is "off". I also agree, much of this can be automated by your practice management system. Every 60 days is a good rule. I have also done every visit. It depends on the type of practice too. Only doing it once a year is a nightmare and setting your revenue cycle up for failure in my opinion.

I have worked in tiny groups where I was actually the person who did it but only had 2 providers. I have worked for large groups where it was shared by appointment scheduling, patient access, billing, and sadly it sometimes made it all the way to coders or A/R folks before being corrected.

 

[kattekatt]

I am the biller, coder, payment poster, eligibility and referral person in my office- 5 providers 3 mid levels- my other half (biller) does all the collections, A&R and denials. I wish i could get help but then i am afraid they will mess it up or do it half way.

 

[julieordway]

I recommend having a dedicated insurance verifier person (non-front desk staff unless they are very trained in the in's and out's of insurance coverage). Every visit gets verified. Our system does run automated EDI eligibility checks but it does not go deep enough. We use it as a preliminary check to make sure the patient is still active with their insurance. Beyond that, we utilize the payors websites to check copays, deductibles, referral requirements. Copays can vary between PCP and specialist offices, and deductilbes will vary as to what they apply to ( office visits and/or procedures). For the most efficient optimization of collections, collect unmet deductibles UP FRONT. We check unmet deductilbes, asertain if they apply to what the patient is coming in for, notify patients prior to their visit with a quick phone call, and collect AT CHECK in. This will save you alot of collection work on the back end.