When the patient arrives the day of the appointment, the first thing your staff should be verifying is the patient’s insurance. Sometimes you find that insurance has changed in just the short period between scheduling and appointment day. Another reason for insurance verification is to prevent or detect insurance fraud/identity theft. According to The Institute of Medicine over $75 billion annually is lost from the U.S. Healthcare System due to insurance fraud. Having your staff check for duplicate records and payment fraud is important. Ensuring your staff is checking the eligibility of insurance before service can aid in the detection of insurance fraud. How does your practice prevent such fraud? Simple, your practices part in it all is to ensure the insurance is in fact tied to the patient. To do that, it is vital that your staff verifies the identity of the patient first and then searches for any records attached to that patient.
Your billing process begins at the scheduling stage. Since the scheduling stage is the first point of contact, it is the first opportunity to assemble the needed data for the billing stage, if the information isn’t collected or accurate, then there will be no way to bill. Your staff need to be aware of all the information they are required to collect from the patients. Usually it helps to have a checklist for the staff to follow to ensure all patient information is collected. It is imperative that the staff collect as much information as possible in this initial phone call. Taking the time to take down patient demographics and insurance can save time, allowing for better accuracy.
Additionally, any existing patients’ information should be checked and verified at the time of their call. Confirming existing patients’ info and that insurance has not changed will prevent issues during the billing process. Before your staff finishes the call with the patient ensure they gather all their current contact information, concerns, insurance information and then proceed to provide them with any pre-visit paperwork. It is important that your staff explains what the patient needs to bring to the appointment, and the potential copay or payment that is expected at the time of the appointment. Here may be a great opportunity to ask the patient for credit card information to put on file to allow for easy billing for co-pays. This not only can be a convenience for the patient, but a safety for your practice to ensure there is one way to collect payment. If the patient does not wish to provide the information over the phone, be sure to include a section in their pre-visit paperwork where they can provide this information.
Does your practice struggle with Modifiers 25 & 59? Many practices we speak with are challenged with when and how to use both modifiers. Coronis Health has created a resource to help eliminate the guesswork.