Changing policies. New forms. Added steps to the process. Pick any of these, yet alone the longer laundry list of the issues related to eligibility reporting, and it is understandable why many practices struggle with staying current and optimizing the tools offered to them. I correlate it to taxes – tax accountants are paid to stay current with everything and so maximize the return to each customer.
Exactly the same can be said for medi-cal eligibility verification. You will find specialists it is possible to outsource to, ultimately optimizing the process for the practice. For those who retain the eligibility in-house, don’t overlook proven methods. Adhere to these guidelines to assist assure you have it right each and every time and reduce the potential risk of insurance claim issues and maximize your revenue.
Top 5 Overlooked Methods Shown to Increase the Efficiency, Accuracy of Eligibility Verification.
1) Verifying existing and new patient eligibility each and every visit: New and existing patients must have their eligibility verified Every. Single. Visit. Frequently, practices tend not to re-verify existing patient information because it’s assumed their qualifying information will stay the same. Incorrect. Change of employment, change of insurance coverage or company, services and maximum benefits met can alter eligibility.
2) Assuring accurate and finish patient information: Mistakes can be created in data entry when someone is trying to get speedy in the interest of efficiency. Even the slightest inaccuracy in patient information submitted for eligibility verification may cause a domino effect of issues. Triple checking the accuracy of your eligibility entries will appear to be it wastes time, but it can save time in the long run saving practice managers from unnecessary insurance carrier calls and follow-up. Make certain you have the patient’s name spelling, birth date, policy number and relationship towards the insured correct (just to name a few).
3) Choosing wisely when according to clearing houses: While clearing houses can offer fast access to eligibility information, they most times usually do not offer all important information to accurately verify a patient’s eligibility. More often than not, a call designed to a representative with an insurance company is necessary to gather all needed eligibility information.
4) Knowing exactly what a patient owes before they even reach the appointment: You need to know and anticipate to advise an individual on the exact amount they owe for any visit before they even get through to the office. This can save money and time to get a practice, freeing staff from lengthy billing processes, accounts receivable follow-up and even enlisting the aid of cgigcm bureaus to gather on balances owed.
5) Having a verification template specific to the office’s/physician’s specialty. Defined and particular questions for coverage related to your specialty of practice will be a major help. Not all specialties are similar, nor could they be treated the same by insurance carrier requirements and coverage for claims and billing.
Since we said, it’s practically impossible for all practice operations to run smoothly. There are inevitable pitfalls and areas vulnerable to issues. It is essential to create a defined workflow plan which includes mix of technology and outsourcing if necessary to achieve consistency and accountability.
We have been a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments. We offer Eligibility Verification to prevent insurance claim denials. Our service starts off with retrieving a listing of scheduled appointments and verifying insurance policy for that patients. After the verification is carried out the coverage details are put straight into the appointment scheduler for the office staff’s notification.