The healthcare landscape has changed, and one of the biggest changes is the growing financial duty of patients with high deductibles that require them to pay physician practices for services. This is an area where practices are struggling to accumulate the revenue they’re entitled.
In fact, practices are generating approximately 30 to 40 percent of the revenue from patients that have high-deductible insurance policy coverage. Neglecting to check patient eligibility and deductibles can increase denials, negatively impact cashflow and profitability.
One solution is to improve eligibility checking using the following best practices: Check patient eligibility 48 to 72 hours well before 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.
Check out patient eligibility on payer websites. Call payers to figure out patient eligibility verification software for additional complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered when they occur in an office or diagnostic centre. Clearinghouses do not provide these details, so calling the payer is important for these scenarios.
Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them regarding how much they’ll have to pay so when.Determine co-pays and collect before service delivery. Yet, even though doing this, you may still find potential pitfalls, like changes in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.
If all of this sounds like plenty of work, it’s as it is. This isn’t to say that practice managers/administrators are unable to do their jobs. It’s that sometimes they need some assistance and much better tools. However, not performing these tasks can increase denials, along with impact cash flow and profitability.
Eligibility checking will be the single most effective way of preventing insurance claim denials. Our service starts with retrieving a list of scheduled appointments and verifying insurance policy for your patients. When the verification is performed the policy facts are put directly into the appointment scheduler for that office staff’s notification.
You can find three methods for checking eligibility: Online – Using various Insurance carrier 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 needed calling an Insurance carrier representative will give us a much more detailed benefits summary for several payers if not provided by either websites or Automated phone systems.
Many practices, however, do not have the time to complete these calls to payers. Within these situations, it might be suitable for practices to outsource their eligibility checking with an experienced firm.
To prevent insurance claims denials Eligibility checking will be the single most effective way. Service shall begin with retrieving listing of scheduled appointments and verifying insurance policy for your patient. After nxvxyu verification is done, details are put in appointment scheduler for notification to office staff.
For outsourcing practices must see if the following measures are taken approximately 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 providers directly and interactive voice response system will answer.
Insurance provider Automated call: Obtaining summary beyond doubt payers by calling an Insurance Company representative when enough information is not gathered from website
Tell Us Concerning Your Experiences – What are among the EHR/PM limitations that the practice has experienced with regards to eligibility checking? How many times does your practice make calls to payer organizations for eligibility checking? Let me know by replying inside the comments section.