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Service Desk is now active!

pVerify now has a ticketing solution! And better yet, it does not require a user/password. (A user will be automatically created once you put in your email – which is optional). You will get 2 emails back from the system if this is your first time. 1) An email saying we’ve received the request and 2) an email to create an account. The later is nice so you can keep track of your ticket. However, we will contact you irregardless of this step, as we work your ticket. The link is here: Please use this for all your issues and other communication needs! We are revamping our customer experience, and this is the first step towards that. Look here for more news regarding the Message of the Day feature, and creation of a user...
3 Common Causes of Insurance Claim Denials and How to Avoid Them

3 Common Causes of Insurance Claim Denials and How to Avoid Them

The expression “garbage in, garbage out” or “gigo” is generally used in IT field that means regardless of how accurate a program’s logic is, the results will be incorrect if the input is invalid. The same applies for medical billing process… if you have the wrong information about patient’s coverage or even incorrect patient demographics, you are risking claim denial or rejection, no matter how good your EHR or your coding is. Listed below are 3 frequent causes of claim denials and rejections for Medical Offices and Outpatient Surgery Centers (e.g. Medicare Denial Codes CO-22 , CO-120, CO-24): a) Outdated information about patient’s Payer Coverage (e.g. Medicare patient switching to Medicare Advantage plan or Medicare patient’s SNF episode or Hospice status, or HMO patient changing their IPA/Medical Group) b) Incorrect insurance related information or patient demographics (such as incorrect Member ID or name, DOB) c) Lack of Pre-certification / Pre-authorization or referral (HMO patient) Sometimes patients will make an appointment with a provider and tell the front office “I have Medicare” when in reality, Medicare might be their secondary payer. This happens when patients are still working (beyond age 65) and have medical insurance coverage from their employer. In that situation, the Medicare coverage offered by their employer becomes Primary and Medicare becomes secondary. However, many patients simply assume that Medicare is their main payer. If you do not verify eligibility and confirm this information, you may end of losing money on the claim since until you bill and collect from the primary payer, Medicare will not pay. You can appeal the claim denial but based on their policies, you may run into issues including...
3 Solutions To Verify Patient Eligibility

3 Solutions To Verify Patient Eligibility

Verifying with insurance carriers on patient eligibility is one of the requirements of any medical practice management. In fact, this is important to the income of a medical office. Medical offices have several ways they can accomplish this. It all depends on insurance carrier and the individual office process. There are also important questions one needs to ask. With a viable eligibility system and a little foresight, it will be much easier to get all the claims. So what are the 3 solutions to verify patient eligibility? Are they time-consuming, error-prone and resource-intensive, or can they be real-time, accurate and automated? 1. Verify Authorization In most cases, a medical practice primary care provider will only be interested in whether or not the insurance coverage is in effect during the time of services, and check for the patient’s responsibility. A specialist should verify whether their services will require a referral or pre-authorization. If the procedure was pre-authorized yet you waited too long to schedule the service, the window of authorization can be closed any time. This is normally the case for certain therapies. To dodge this denial, it is advisable to be cautious of the deadlines and always submit the claims as soon as possible. Authorization is normally open for less than 30 days. When it comes to referrals, it is necessary for specialists to ensure their patients acquire referrals from their primary care givers before paying a visit to the office. This will avoid any surprises. But there comes a time when the documentation you provide differs from plan to plan. In that case, you must make sure all referrals are documented in the patient’s...
6 Patient Eligibility Verification Best Practices

6 Patient Eligibility Verification Best Practices

Verifying patient eligibility is becoming an indispensable process when it comes to billing patients, getting paid by insurance providers, and the overall management of practices’ revenue cycles. With the rise in high-deductible and cost-sharing insurance plans, more and more patients are required to make payments at the time of service, though many patients are unaware of that fact.

Eligibility verification—particularly when done in advance—solves this problem, allowing you to give important information to your patients before their appointments.

How to Choose the Right Patient Eligibility Verification Processes for Your Practice

How to Choose the Right Patient Eligibility Verification Processes for Your Practice

If you thought that medical coding and billing used to be a complicated process, it’s likely only become more complicated since the recent transition to ICD-10. In addition to this change, the recent growth in the number of high-deductible and cost-sharing insurance plans, as well as the Affordable Care Act, have likely also had some sort of effect on your revenue cycle.

The solution to managing all of these recent changes? Patient eligibility verification.