Win The Losing Battle-Verify

August 5th, 2014 - Donna Weinstock
Categories:   Collections   Insurance   Reimbursement  
0 Votes - Sign in to vote or comment.

           

Do you feel like you are fighting a losing battle? Are you watching your account receivables going up and your collections going down? Is your cash flow suffering? What is a practice to do?

 

One of the most effective ways to keep your cash flowing is by checking your patient’s benefits before the patient arrives for their appointment. It is so easy to say that there isn’t time to verify benefits for every office visit, but the truth is “knowledge is power.” Knowing whether your patient’s benefits are active can help you collect at the time of service. Starting your collection process on the front end saves time on the back end.  Face to face is always the best way to collect money from patients, therefore knowing what a patient will owe prior to the visit is beneficial.

 

With the varying policies, deductibles sky rocketing and insurance coverage changing often, a practice often find themselves without reimbursement when the claim is finally processed. Too often you see “no coverage for the person.” It may be that the patient left his job and did not keep his insurance, or it may be that the group changed and the patient forgot to give you his new insurance card. Time is spent contacting the patient only to find out that a claim needs to be re-billed or reprocessed. Had you known ahead of time, the claim may have been paid the first time it was submitted.

 

If your practice does not already do so, look into verifying eligibility, benefits and coverage on-line. Your electronic health record may have a feature to check benefits directly through their system. If not, contact your clearing house and/or insurance carriers to learn the easiest way to do electronic verifications.

 

Finding out the patient has no coverage allows you to collect payment at the time services are rendered.  A patient may say they don’t have their check book or credit card with them; be ready to give them a statement at that time. Timely statements allows for faster collection of money owed.

 

Verifying insurance coverage prior to a surgery allows the practice to not only know if the patient is covered, but if the procedure is covered within the policy guidelines. Certain policies have limits on coverage and medically necessity. For this reason, it is important to know if the surgery requires precertification. Without the proper documentation, coverage will be denied.

 

Consider keeping credit cards on file. This can be tricky as you will need to verify that the numbers are secure. Whether you set up a system in your office or hire an outside credit card company to keep these credit cards, having them available allows you to charge the card with permission.

 

Have a financial policy that is specific to the expectation. Your policy should state when a payment is due by the patient or guarantor. Be specific if you want to charge small balances following insurance processing without billing patients. Have a place for the patient/guarantor to sign the financial policy. Keep the original and give the patient a copy of the policy. This allows them to refer to it.

 

Depending on whether you are in or out of network with insurance companies, and how your contractual agreements are worded, a practice may be able to collect deductibles and coinsurances at the time of service or prior to the service in the case of a surgery. For this reason, knowing a patient’s benefits is important. This is especially beneficial for scheduled procedures or surgeries.

 

A patient with a high deductible may have trouble paying that deductible. When a practice is able to collect this upfront, it saves time and expense after the procedure has occurred. It is important to know how your contracts read to stay in compliance with the insurance companies.

 

Why not have practice policies to collect on auto accidents and certain types of litigation up front? More and more practices are adopting this method instead of filing a lien and waiting years to receive reimbursement.

 

Though time consuming, by verifying benefits your practice has the potential to save time and money. You are prepared and able to address the finances with the patient prior to the office visit or procedure. It allows for easier collection of money due to the practice. Collection at the time of service will decrease your accounts receivable simply by not adding to it.

 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Billing for Telemedicine in Chiropractic
January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...
Q/A: Can Chiropractors Bill 99211?
January 14th, 2020 - Wyn Staheli, Director of Research
Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code...
Denials due to MUE Usage - This May be Why!
January 7th, 2020 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
CMS assigns Medically Unlikely Edits (MUE's) for HCPCS/CPT codes, although not every code has an MUE. MUE edits are used to limit tests and treatments provided to a Medicare patient for a single date of service or for a single line item on a claim form. It is important to understand MUE's are ...
CMS Report on QPP Shows Increasing Involvement
January 6th, 2020 - Wyn Staheli, Director of Research
MIPS 2018 participation increased according to the final report issued by CMS on January 6, 2020.
CPT 2020 Changes to Psychiatry Services
January 3rd, 2020 - Namas
As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and ...
Medicare Changes Bilateral Reporting Rules for Certain Supplies
December 30th, 2019 - Wyn Staheli, Director of Research
DME suppliers must bill bilateral supplies with modifiers RT and LT on separate claim lines or they are being rejected.



About Codapedia by innoviHealth Contact Us Terms of Use Privacy Policy Advertise with Us

innoviHealth - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems, Inc. - CPT® copyright American Medical Association