Verify Everything and be Nicer to Providers

Insurance Verification

A patient’s insurance can change at any time. Their employer could change plans. The patient could change jobs. The patient could become eligible for Medicare services due to age. The patient could lose insurance coverage altogether.

Hypothetical:
Jasmine is being seen by your office. You have Aetna commercial insurance on file for her. Unfortunately, this is not verified at the time of service. Once the visit is completed, your claim is submitted to Aetna. Two weeks later, you receive a response that the policy is no longer active. Multiple phone calls are made to the patient for updated information, to no avail. You now must resort to sending out a statement to the patient for payment or updated insurance information. After two statements have been mailed, the patient calls to inform you of her new insurance; a state-provided Medicaid insurance for which you do not participate.

The charge for the initial visit is $250.00. The average cost of submitting a statement to the patient is $5.00 per statement. Failure to obtain correct and valid insurance information has now cost the practice $260.00. What can we do about this?

Today’s technology provides the resources to verify insurance for just about every patient. For most practices, the only burden on your staff will be to ask the patient for his or her current insurance information and then perform the steps to verify the information. This can be done in a day or two before the appointment, or at the time of service. Insurance can also be verified at the time an appointment is made but remember that insurance can change with a moment’s notice, so it would be advantageous to check it again closer to the time of service.

Having accurate insurance information for every patient is vital to your practice. By having this information, you will decrease your adjustments, staff time, and frustration on everyone’s part.

Doctors are sick of business people telling them what to do and how to do it. Data coming on this soon.

If you are a physician in a PE backed practice or hospital, you may feel this more than physicians in independent groups or practices. But this advice goes out to all healthcare managers in bigger healthcare settings.

If you are going to tell a provider what to do, please acknowledge that they know more about clinical work than you, and you are just trying to troubleshoot back office problems by seeing if there are clinical solutions. For example, if there is missed revenue on the table due to coding issues, go to your docs to see if they can help you solve the problem — don’t go to them and tell them that they are the problem.