Radiology Coding Alert

Never default to confirm enforcement of patient’s insurance before first visit.

When you are getting new patients to your practice, you need to verify their insurance quickly. Failure to do so could lead you to many risks to your practice that could range from effects to your patient relations to losses to your practice.

When it comes to avoidable cash flow problems, poor insurance verification is “the single most deadly income killer to practices,” says Cyndee Weston, CPC, CMC, CMRS, executive director of the American Medical Billing Association (AMBA) in Davis, Ok. “Failing to verify benefits causes practices to lose otherwise collectable insurance dollars.”

Help’s here: We asked the experts for some advice on insurance verification best practices. Take this knowledge to heart, and you’ll be on your way to minimizing the risk that there’s an insurance snafu with a patient.

Verify Info Well Before the Initial Visit

According to Alice Scott, co-founder of Solutions Medical Billing in Rome, N.Y., your practice should make every effort to verify insurance information before the patient reports to the practice for her first visit.

“It is a task that can be time-consuming, but not doing it often results in practices writing off charges,” warns Weston. If you cannot verify the full insurance picture pre-visit because you lack certain data, get any missing information from the patient when she arrives for the first time, Scott says.

Tip: Place a single staffer in charge of verifying patient insurance. This individual must understand the process of verifying insurance, and have enough extra time to take on the task. Who performs this task is not necessarily important, Scott says. It could be anyone “from the receptionist to the office manager,” as long as she can perform the job, Scott explains.

Be Precise In Collecting Patient Info

Getting a copy of the patient’s insurance card “is ideal — then you know where to call, and you have all the pertinent data in front of you,” Weston recommends.

Follow Up With Payer to Make Final Verification

Once you get all of the patient’s pertinent insurance information, you need to vet the data with the payer.

According to Scott, when the practice rep contacts the payer, she should first check all the information that the patient provided.

 “Also, don’t forget to ask about the patient’s deductible status,” suggests Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “Many patients are now enrolled in high-deductible health plans with annual deductibles reaching into the thousands of dollars. As long as the deductible is unmet, the patient is usually responsible for the full allowed amount, unless the service is deemed preventive. Knowing what the patient’s annual deductible is and how much of it he or she has met at the time of service is useful information,” Moore adds.

Remember that issues like copayments, co-insurance and deductible must be vetted thoroughly to avoid any confusion with the patient. For example, there might be different copays for different types of services and providers. Weston says that her personal insurance copay is $20 for many services. “But if I go to, say, the ER, I have a $400 deductible,” she explains. “However, if I am admitted, the copay is waived down to $200.”

Much like copayments, checking about secondary coverage is vital to spot-on verification — even if the patient reports that she doesn’t have secondary coverage. Some patients might have secondary insurance that even they don’t know about, relays Weston. A quick check with the payer on any other insurance the patient might have can save you future trouble, Weston says.