Checking eligibility is key to success: write off less, get paid moreDecember 22, 2016
Getting paid for your services is not always an easy process for medical professionals. When a patient either knowingly or unknowingly presents incorrect insurance information at the time of their visit, your collections process becomes significantly more difficult. Having a team to supply your professional medical billing management can make all the difference.
In the following example, the patient presented an outdated insurance card at the time of service. If they had used the correct card, the services would have been covered through insurance and both billing and collection on this account would have been a smooth process. An incorrect address and phone number further complicated the issue making this claim very difficult to manage through the clinic billing office.
Our client in this case has a small staff at the clinic. Without ORI’s help, this account would have likely been written off and the revenue lost. Rejected insurance claims are common place in a medical billing office. However, the claim noted in this study was being rejected initially on the basis that the coding for the service was incorrect. This was confusing because it was clear this service was covered under the patient’s medical plan. Through online eligibility, ORI was able to uncover that the patient had presented an old insurance card at the initial time of service. The process had become further complicated by a move the patient made making their address and phone number incorrect. The incorrect address would have been caught either during the statement submission process which flags invalid addresses, or during ORI’s skip tracing process run on all return mail.
The outcome was the medical office was in full for both the insurance and patient self-pay portions of this claim.
The primary issue with timely payment in this instance was the outdated insurance card. Spending the extra time upfront to check the card and run on-demand eligibility is well worth the effort in the end. In addition, if the clinic had requested the new insurance information at the time of scheduling, the daily scheduling eligibility report would have flagged the patients visit. The patient can then be contacted and asked to bring in their updated information or cash, check or credit card!
Outsource Receivables can help your office implement a process of upfront insurance verification. These tools and tracking allow your office to look up insurance coverage, in real time to ensure the procedure in question is covered by a patient’s insurance.Outsource Receivables Inc. provides professional medical billing, process management and expertise to surgical, family practice, specialty clinics, therapy offices, and mental health clinics throughout the Upper Midwest. Contact us for more information and a free revenue cycle management assessment.