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.
CMS released proposed rules that require many types of insurers to provide electronic health data in a standard format by 2020.
HIPAA AND THE TCPA
Did you know that the Telephone Consumer Protection Act (TCPA) and HIPAA go hand in hand?
Recently in 150 countries around the world, WannaCry ransomware infected more than 200,000 computers in hospitals and healthcare information systems. The initial virus has been slowed thanks to a “kill switch” developed by a British researcher; however, it’s suspected that another wave of copycat malware could hit the healthcare community.
Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS’ Office of Inspector General said in a study released Thursday. The overpayments, which allegedly stemmed from incorrect coding and poor documentation, accounted for more than one-fifth of the $32.3 billion the CMS paid for E/M services that year. E/M services are basic patient health assessments performed at a physician’s office or clinic.
Today, more than ever, people have the ability to automate the dull tasks of daily living, so there is more time to spend on activities of value. Bills can be set to autopay, so you can spend the evening with your family instead of hunched over a checkbook or laptop. Even dog food can be autoshipped, so you can take Fido on a hike on Saturday morning instead of schlepping to the pet store because there’s no more kibble. The benefits of automation in your personal life are clear to see, so why spend so much time on repetitive, manual tasks in your professional life? It feels like “work,” but that doesn’t mean it is valuable.