Practice Management Alert

Billers that take advantage of technology make their jobs easier

Verifying each patient's insurance every time he comes into your office may seem like a tedious task, but it can save your office thousands in lost payments.

Small changes matter: Even if the patient's insurance hasn't changed, sometimes the copays, the terms, and the precertification phone number can change.

Therefore, it's important to get a copy of that insurance card at every visit or at least compare the card to your copy of the card and verify that nothing has changed, says Deb Flanagan, recovery unit manager for Inland Cardiology Associates in Spokane, Wash.

Example: A patient comes into your office. The physician performs an exam and administers an injection, and then the patient checks out at the front desk. Because the patient states she has the same insurance as she had at her last visit, you collect a copay of $15, which was the copay of record.

Hidden hitch: You process the claim and find out the patient still has insurance with the same carrier, but her employer has changed the terms of the insurance and now has a $40 copay. In order to collect full payment, you now need to send the patient a bill for $25 and hope she pays it. If this happens with multiple patients, you-re racking up costs that  could have been avoided if your office had verified patients- insurance before their visits.

Capture Insurance Info ASAP

Eligibility verification means checking the patient's insurance information to be sure that a patient belongs to the group you-re billing and that her group identification and member ID are correct. You should obtain this information prior to the patient's initial visit when possible, experts say.

A patient's insurance company name and ID number may be all that you need. First, call the patient to get that information before her visit or ask for it when she makes the appointment, then verify the information by calling carriers directly.
 
Take these steps: -We ask about insurance at the time the appointment is made,- Flanagan says. -If we need to verify insurance on a patient, we call the referring doctor to see if they have the insurance information on file. If they do not, we will contact the insurance company directly and as a last resort go to the patient.-

Helpful hint: Regardless of whether you obtain this information before the patient comes in, make sure you copy her insurance card before you provide services.

Let the Internet Work for You

Take advantage of carrier Web sites to make insurance verification less time-consuming. Find out which carriers you deal with have verification Web sites and sign up for them, says Jeannette Thigpen, billing/office manager and medical billing specialist with Omnicare Health Centers in McKinney and Plano, Texas.
 
Example: United Healthcare offers a Patient Eligibility link on its Web site. Registered users can enter patient information and verify insurance eligibility.  By checking a patient's insurance eligibility, you prevent not only claim denials but also payment delays that arise when patient insurance information doesn't match up with the carrier-s.

Beware: -Should we have the incorrect insurance information, we would have billings sent out to incorrect carriers, delayed payments, and charges dropped to patient responsibility- resulting in patient calls and collection calls, Flanagan says. -Equally important is that many insurances are implementing shorter timely filing periods, so late claims could result in denials and lost revenue.-

Costly mistake: When her practice doesn't verify insurance, -we wind up with large bills not paid for, and you have to practically beg the patient to pay: But after the service is provided, patients will come back at you with a lot of excuses,- Thigpen says.