COMMON POTHOLES IN A MEDICAL
1. The registration process
Careful analysis of your practice's registration process is the most important step in identifying possible potholes that could affect your revenue down the line. There are several key steps taken at this stage.
A. Collecting patient data:
Once the patient completes the registration paperwork, is this information being reviewed by your check in staff member and confirmed with the patient? Ilegible apartment numbers, zip codes, street names, etc., these are all things that many times are disregarded and thought of as irrelevant, but if the patient needs to be billed for a coinsurance charge, deductible, etc., you will not be able to accomplish this due the invalid information collected and entered.
B. Recording patient insurance policy:
Taking a photocopy of the patients's insurance card is a vital step that can not be missed. Any questions about claims mailing addresses, group numbers and so on, can be confirmed later on in the collections process if needed. Additionally, making sure that the correct insurance profile is selected in your billing program is also key. Many carriers have several mailing addresses depending on the policy and ensuring that the correct address is recorded is crucial. In a day where almost if not all claims are going electronically, the address isn't needed for the intial claims submission for any future appeals or medical records that may need to submitted.
C. Proper Insurance Verification:
Checking for a copay is pretty simple to verify and many online services like Emdeon and Availity will provide this quickly. However, when we enter the world of a PPO, POS, EPO and anyother type of non HMO policies, you now many need to verify the patient's deductible and/or coinsurance. Too often practices think that you verified and collected the patient's copay, so everything is fine. Unfortunately, many individual policies nowadays have very limited benefits. From a flat allowed amount paid (vs a percentage) to a high individual deductible, these are areas that catch medical practices by surprise. Instead of receiving a payment for an office visit of $65.00 because you've already collected the copay, you find that you only received a payment for $42.00 and need to bill the balance to the patient because they have a 60/40 policy. This type of error made one time seems irrevelant, but when done many times a month it adds up. Making sure that Check-In understands medical policies and its components (deductible, limitations, coinsurance, etc.) is imperative to ensuring that as much money is collected upfront to avoid delay in payment in the future.
Observing your Check-In staff member for a couple of days to see what their process is could serve as an eye opener. Maybe you had no idea that he/she had no knowledge of a very vital step that needed to be taken. Communicating to him/her how important their role is in the practice's revenue process can also help them feel as though they are part of something bigger. That what they do has a large impact in the entire process.
Stay tuned for other potholes and processes that will be discussed:
Authorizations
Customer Service
Effective Communications
Check Out
Scheduling/Appointments
Care Coordination
Referrals
....And many more
