Payer Success Starts with Empowered Medical Practice Staff

Think about it this way: What if you had a car and no gasoline, a sailboat and no sails, a lamp and no bulb? Then, how can you expect your staff to perform at the peak of their skill set if the proper tools are not provided to them?

I'm talking about obtaining authorizations and verifying a patient's insurance prior to their arrival. There are several things that you can provide your staff to insure their success in obtaining the correct information, such as :

1. Elect an administrator in your office to obtain passwords and manage all of the accounts for online verification. This would be someone on your staff who understands the insurance company verbiage (HMO, PPO, EPO, POS, etc.), who is computer savvy, or at least not afraid to learn, and someone responsible who has been with or will be with your practice for a while.

Many insurance companies are paring down or outsourcing their customer service call-staff departments. Many of the representatives answering the phone are reading from a script, and have no idea what they are saying. Turnover in this position is very high, so the chances of your staff obtaining the proper authorization or verification the first time is very questionable.

By having someone in your office that can log-in, set up each user with their own log-in, password, and level of security will help keep this task very organized. You won't hear, “Who has a log-in for Blue Cross?” or “I can't log-in anymore because my password changed!” Your insurance administrator will be able to manage all of the insurance company websites and log-ins for you and your staff, taking this burden off of you.

There will be times when the website cannot provide the very specific information on a patient's plan, especially with the insurance companies adding new plans nearly every month. But once your staff has spent the two to three minutes online obtaining a majority of the information, then they can call and ask for the specific information that they need. This will decrease the time spent obtaining the benefits by several minutes per patient.

2. Print the information found on the website. This is your version of the insurance company “recording the phone call for training purposes” and your best weapon for appealing denied claims. If calling, be sure to get the first name and last initial of the person you spoke with as well as the date and time when obtaining the eligibility, benefits, and authorizations.

Insurance companies are always so vague and use phrases like, “Not a guarantee of payment,” leaving you wondering if you will ever be paid for your time and efforts. Let's face it: You did not go into this career to negotiate payment for the services that you provide. You went into this career to help people. Unfortunately, this is where we are within the industry when accepting a patient's insurance as payment. Your best defense is a really good offense. So be sure to tell your staff to print what they find on the insurance website so that you can provide your billing department with a tool to help get you paid. Even if you are using an EHR, you can “print” a PDF and attach it to the patient account in your system. By obtaining the contact information, date and time, you are also increasing your opportunity for being paid, even if you have to appeal.

3. Train your staff to understand that all authorizations must be in writing. It's very easy to create a form in a word processing program that shows the date range of the requested authorization, the procedure you want to code for, and the number of visits you are requesting.

Many insurance companies do not like to provide this and they claim that “their verbal auth is good enough. After all, I will be the one approving it!” But what ends up happening, is that “Laurie L. no longer works here, I'm the new case manager or authorizations manager and I did not approve that.” Now you are out payment because you have no physical proof that the correct authorization was obtained.

So by providing your staff with a few tools, you will surely be much more successful in obtaining payment for your services.

Next week: How to properly and effectively train your staff for the best results.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.