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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rejections for Medical Offices and Outpatient Surgery Centers (e.g. Medicare Denial Codes CO-22 , CO-120, CO-24): a) Outdated information about patient’s Payer Coverage (e.g. Medicare patient switching to Medicare Advantage plan or Medicare patient’s SNF episode or Hospice status, or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

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

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

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.

When Should I Verify Patient Eligibility?

Even just a few years ago, verifying patient eligibility once a year was good enough, as most patients stuck with their insurance providers for the long haul. However, the market is changing, and more and more patients are switching over to higher deductible plans and plans based on cost sharing.

Today, a patient’s insurance information can change over night—which is why it’s increasingly important to regularly verify your patients’ eligibility. But when, exactly, should you verify patient eligibility?

5 Tips for Improving the Efficiency of Your Practice’s Front Desk

For most medical practices looking to improve their efficiency and the care they provide to their patients, there is always room for improvement. But many times, deciding where to start can be the most overwhelming part.

Oftentimes, medical practices turn first to their front desk or office, as this is where the patient begins their experience.

Save Time and Money by Verifying Patient Eligibility

Recently, insurance policies have been changing, putting more and more of the financial burden on the patient, in the form of copays and high-deductible plans. Because of this change and this increase in financial obligations that patients are faced with, it’s becoming more important for medical practices to verify each patient’s insurance eligibility–before the office visit, if possible.

Verifying patient eligibility before a patient sees a physician has a number of benefits, and overall will save your practice both time and money.

3 Ways Medical Practices Can Increase Revenue at the Front Desk

Most medical practices are looking for more ways to increase revenue and close the gaps in delayed payments. Added to all of the latest trends in financial management are new regulations and changes in patient payment dynamic. Understandably, many practice managers find the overload of information counterintuitive to making sound changes that will beneficially impact their bottom line.

Problems with Electronic Patient Eligibility Solutions and How to Overcome Them

Most practices have some sort of protocol for checking patient eligibility prior to appointments. While some still rely on manually checking patient eligibility via calling the insurance providers, few private practices can spare the man hours it take to verify coverage in this manner. For those who do maintain patient payment information in-house, there are a number of options. Most different modes of checking patient eligibility have their own benefits, as well as problems to overcome.

The Importance of Patient Eligibility Verification to the Revenue Cycle

There are a number of options available to verify patient availability and all of them will more or less impact the revenue stream in a number of ways. One concern is in how well the mode of verifying the patient ahead of time improves the rate of payment from both provider and patient. Another consideration is in the amount of time employees spend in the verification process – for example, manual verification will cost more in employee time than electronic verification.