As you well know, you aren’t getting reimbursed if you bill the wrong payer, and front-end staff have even more pitfalls to avoid in ensuring they have the correct insurance information.
Insurance verifiers, schedulers, and registrars need to be fully aware of why gathering insurance information from patients is important. Especially so staff do not feel like they are just going through the motions.
Designing a list of coordination of benefits questions for patients that completely captures their payer information, for every payer they have, is also necessary so that you are billing the payers in the correct order.
In states with a Medicaid work requirement (currently AR, KY, AZ, WI, IN, MI, ME NH), you can no longer rely on a patient’s financial information to determine if they are eligible for Medicaid. Rechecking each patient’s eligibility will be necessary to determine if they have not met your state’s reporting requirements and do not have insurance.
Giving staff background on the reasons behind the questions on the Medicare Secondary Payer questionnaire can empower staff to effectively collect the correct information from patients.
Perhaps there is just one payer you are having trouble verifying. If you are aware of this already, round with your front-end staff to determine what difficulties they are encountering. If you don’t have this in-depth view of your reimbursement, work with your fellow leaders as well as your patient financial services staff to determine if one party is causing your problems. Utilize a payer scorecard or a denials dashboard to learn where you are missing the mark.
If you have any questions about this topic, or if you want to share strategies used at your organization, fill out the form below!