Patient Insurance Verification: Saving your Practice's A/R

Just as a teenager at a fast food drive through asks, “Would you like fries with that?” your front office staff must be asking “Has your insurance changed since we last saw you?” each time a patient makes an appointment. It takes mere seconds to ask, and your return on investment is always going to yield excellent results.

Let's take John Smith who made a call moments before your staff left for the day. Your front office staff was in a rush, as they had to pick up their kids from school, and since Mr. Smith was a return patient, his information was already in your system. The appointment was made and Mr. Smith walks into his appointment. This scenario already has put you behind in sending out your claims.

Your front-office staff did not have time to re-verify the Blue Cross insurance to make sure he was still covered under his policy he used on his last appointment. Now, let's say Mr. Smith just became eligible for Medicare, but he knows that there is a small deductible that his secondary will not cover. Mr. Smith thinks (and they really do, folks) that they can pick and choose what insurance they use. Since Blue Cross only has a $10 copay, he has decided to continue to “use” that insurance. You turn in your claim, and you get a denial from Blue Cross because as soon as Mr. Smith became eligible for Medicare, his Blue Cross plan terminated.

A good billing company will alert your staff immediately - well, two weeks from the date the claim went out - that there is a coordination of benefits issue that needs resolving. So the phone calls to Mr. Smith have begun. Mr. Smith just left for a trip to Italy with his lovely wife for a month to celebrate their 50^th wedding anniversary. He has no idea that his claim is now 45 days out and you have no way of getting his Medicare information from him. Mr. Smith returns to the country and hears your several messages. He immediately calls you back with the correct information. He apologizes profusely, and you now have the ability to bill his claim to Medicare. By the time the claim is paid, it will be over 60 days since Medicare now has to evaluate to make certain they are the primary payer, delaying payment to you.

Another scenario, which I know most physician offices employ, is taking a copy of the card each time the patient comes in for an appointment. This is better than not asking at all, but the above scenario could still very well happen. If your staff is obtaining the insurance card the moment the patient walks in and it is not immediately verified prior to seeing the doctor or nurse, you still risk the same end result of delayed payment.

Another similar situation is that a patient has multiple insurances or is on their spouse's plan. As I mentioned above, the patient does not have the luxury of picking and choosing which insurance they need to provide to you. There is a primary, a secondary, and sometimes a tertiary. In that order is how you need to bill. The other insurance companies all know who is supposed to pay first, second, and third. If you do not bill in that exact order, the insurance company will deny the claim. Mr. Smith didn't want to pay that Medicare deductible, but instead the smaller amount: the $10 co-pay. This is not his choice. Be very careful in making sure your front-office staff obtains all insurances that the patient has.

One last scenario: The patient has a plan with a very high deductible, say $5,000. They tell your staff that they would rather pay cash instead of paying on the deductible. This is not legal. If your staff is aware that there is insurance to bill, you need to bill it. All sorts of issues can arise from this. For instance, the patient may come back and decide that after all was said and done, the amount of cash she paid equaled her deductible after all, and that she wants all of that money to now go towards her insurance deductible. Now, you have to turn around and submit new codes and dates of service to the patients deductible. This will throw up a red flag to the insurance company, prompting an audit on all of your accounts with them. You don't need that headache.

It's just so quick and simple to ask, “Has your insurance changed since we saw you last?” at the initial phone call can save you hours of headaches and delayed payment. You owe it to yourself and your A/R to spend the few minutes it takes to be proactive.