As we take our journey around the Revenue Cycle circle, our next stop is at preliminary systems – scheduling, eligibility verification of benefit coverage, and authorization of care. This is the first time our practices interact with a patient, so it’s vital to remember that you never get a 2nd chance to make a 1st impression.
Believe it or not, the reimbursement process begins with the first contact a patient has with a practice. Scheduling (welcome) is not only offering patients a feel for how your clinic runs, but it also sets the stage for positive cash flow. Let patients know that they may have an upfront financial obligation, and you will provide all insurance details to them at the first visit. Be sure that all of the patient’s demographic and insurance information is obtained during this process so you are able to perform a benefit check.
(Keep in mind – it is vital that all managed care contracting and credentialing has been completed prior to scheduling a patient. You won’t be reimbursed if the provider isn’t credentialed yet!)
With deductables, co-insurance and co-pays on the rise, many patients agonize over whether or not they can afford to take care of their health. Personally, this is a scary and upsetting realization. Nobody should feel like they need to put off taking care of their health due to money. That’s why eligibility verification of benefit coverage is so important. Through benefit checks, you are able to alleviate any stress from patients, letting them know what will be expected from them financially. When calling insurance companies or obtaining information through an online portal, it is important to learn:
- If your practice is in network
- If the patient has a deductible and co-insurance responsibility, and how much has been paid to date
- If the patient has a co-pay amount
- If the services the patient is scheduled for are covered under the policy
- If any authorization protocols are necessary for reimbursement of services
Once the patient is physically in your doors for his/her first appointment, encourage your administrator to discuss the benefits in detail so there is no confusion. Following this discussion, have the patient sign a written financial policy stating he/she understands his/her commitment to your practice.
Our last arrow of discussion today is “Authorization of Care.” Authorization is not only a method used by insurance companies to manage their costs for medical coverage, but it also gives patients extra confidence that their healthcare services will be covered. It is important that you are timely on all authorization requests and your documentation clearly states the medical necessity need for continued care. Denial of authorization is on you, as the most common reason for denial or reduced visits is documentation issues. Should there ever be a denial, don’t take “no” for an answer. Call the payor and work with the reviewer. Sometimes, it is helpful to have the treating provider and patient call instead of the administrator. Most importantly – don’t give up. The worst thing that could happen is authorization is denied and the patient is forced to decide between paying out-of-pocket or self-discharging. Whenever possible, be an advocate for your patients and fight for authorization so they don’t have to make that choice!
Every single step in the revenue cycle effects your reimbursement and the patient’s experience. Again, reimbursement begins at the preliminary systems, and continues until the account is paid in full. I hope you found this information useful for your practice. As always, I encourage feedback and additional ideas so practice owners and administrators across the globe can benefit from networking. I look forward to writing next week on clinical documentation & CPT code selection, compliance, and timely billing submission. Until next week!