March 22, 2024 | By Carol Ittig, MBA, CMPE
Introduction:
In the fast-paced world of healthcare billing, clean claims are the key to maximizing revenue and minimizing headaches. A significant contributor to claim denials is inaccurate patient eligibility information. This article explores a multi-step approach to patient eligibility verification, empowering your team to submit clean claims from the get-go.
Step 1: Schedule Smart with Basic Verification
The fight against denials starts at the scheduling stage. Don’t wait until claim submission – utilize your PM system’s eligibility verification tools. The 270/271 report unveils crucial details: plan type (HMO, PPO etc.), insured information, ID verification, and assigned PCP. Armed with this knowledge, schedulers can proactively address concerns, like referrals or authorizations, during appointment confirmation calls.
Step 2: Deep Dive Verification – A Week Before
Take verification a step further with a dedicated team conducting a thorough review one week prior to the appointment. This verification department directly contacts the insurance company to confirm benefits and eligibility. Summarizing benefits in an easily digestible format empowers staff to collect accurate co-pays and deductibles during the visit. This advanced window allows time to secure authorizations/referrals and tackle potential issues like Third Party Liability (TPL) or Coordination of Benefits (COB).
Double Down on Data Accuracy
Even a seemingly minor typo can derail a claim. Develop a system for meticulously reviewing and confirming patient demographics during intake. Understanding specific insurer requirements, like mandatory middle initials, ensures claims are submitted flawlessly on the first attempt.
Staying Current: The Importance of Regular Updates
The impermanence of employment and insurance plans necessitates regular patient information verification. Don’t make assumptions – confirm details at every visit, particularly for established patients seen less frequently.
Embrace Technology: Streamline with Electronic Verification
Consider implementing electronic eligibility verification systems. These tools provide real-time updates directly from insurance companies, minimizing errors and streamlining the process.
Knowledge is Power: Stay Informed on Insurance Updates
Staying abreast of insurance plan changes and requirements is crucial. Many insurers offer provider resources on their websites, keeping you informed of the latest protocols.
Communication is Key
Develop clear communication protocols to ensure accurate information is collected from patients and seamlessly relayed to billing staff. This collaborative approach minimizes errors and maximizes efficiency.
Conclusion:
By implementing this multi-pronged approach to patient eligibility verification, you can significantly reduce denials caused by inaccurate information. This translates to time saved, improved cash flow, and a smoother experience for both your practice and your patients. Remember, clean claims are the first line of defense in the battle against denials. Start strong, and watch your revenue cycle flourish!
