By Jim Knaub
The computer cliché “garbage in, garbage out” certainly applies to insurance claims, even if they’re not electronic claims. In an imaging facility, putting out the trash begins at the front desk with the first phone call. It seems simple for a sophisticated organization such as an imaging facility, but a surprising number of these facilities run a loose operation at the front desk.
As AAPC’s Sheri Poe Bernard, CPC, CPC-H, CPC-P, CPC-I, wrote a few years ago in Radiology Today, on the first call the staff member needs to query the caller to confirm “the new patient’s insurance will cover the visit. If the patient doesn’t have insurance, he or she should be briefed on your practice’s payment policy.” That information includes both the group plan and the member number.
But just collecting information isn’t enough; management needs to make sure the responsible staff member confirms a patient’s eligibility before the encounter. Doing so ensures you’ll be able to submit a clean claim and the staff can determine what copay may be due and whether any preauthorization is needed, which is increasingly common. Poe Bernard points out that this confirmation is now usually done on the payer’s website. If a patient’s eligibility can’t be confirmed, a staff member needs to contact him or her before the appointment to obtain or correct the necessary information.
Upon the patient’s arrival, front desk staff must verify the information, starting with the patient’s identity. Medical identity theft is a real threat. Make photocopies of the driver’s license and insurance card for every new patient. For established patients, confirm that no changes have occurred in personal or insurance information since the last encounter. Remember that Medicare requires the name on the claim to match the Medicare enrollee’s name exactly. This is a job for detail-oriented people. As Poe Bernard wrote. “Simple mistakes—if the private insurer’s group number has been transposed, the patient’s address is outdated, or the patient’s marital status has changed—can interfere with communication basics requisite to timely payments and add more than a month to the payment cycle.”
As so-called consumer-directed healthcare plans expand, greater financial responsibilities shift toward the patient. These high-deductible health plans with a health reimbursement savings account mean more care should be paid at the time of service.
Many facilities have been slow in identifying patients with consumer-directed healthcare, Poe Bernard wrote. As more patients become accustomed to these plans, payment should be easier to collect, but the desk staff have to be trained to approach collecting money properly. It is a new task for many healthcare support staff.
“Also, once the employer’s deposit in the fund is depleted, the employee pays out of pocket for a larger portion of healthcare services, usually 20% to 30% for everything except preventive services,” Poe Bernard wrote. “Patients accustomed to a $20 copay experience healthcare sticker shock with consumer-directed healthcare, and this too delays payment.”
Avoiding balance billing is worth the effort. It is not always possible to collect up front, but emphasize to the staff that such collection, where possible, is important to the facility.
— Jim Knaub is editor of Radiology Today.