Training staff to follow payer policies makes sense, but what happens when that negatively affects patient care?
Imagine our surprise when we found out yesterday that a front-office staff person turned a patient away from an appointment at a physical therapy practice because Blue Shield requires a prescription from a doctor and the patient did not have that. She read the insurance verification from the intake specialist that said, "Prescription required by Blue Shield," and assumed the patient couldn't be seen. So technically, the front-office person was following insurance guidelines. But, why did she not stop, take a moment, and ask the question "Is there another way we can see this patient for her evaluation?"
I bet this happens more often than you might think. Employees are put on the front line, and perhaps are not trained well-enough to ask questions or think beyond payer or practice policies - or maybe, they are afraid to make a mistake. However, either scenario can be managed quite easily.
In the above situation, the therapist could have seen the patient and faxed the evaluation over to the physician's office for a countersignature. The patient could also have been seen on a cash basis - which the patient actually suggested and still was turned away by the front-office person. The front-office person could have dialed up the physician's office and asked for the prescription to be faxed over. The patient had seen the physician for her ankle and the office just did not get the prescription over in time.
The "B-side" to this situation is customer service. The patient left very upset, stressed, still in pain, and ready to sit down in front of the computer to blast the physical therapy practice over social media for being so rigid. Once that gets out there, its tough to make that kind of smear go away. So, the patient was contacted by the owners, and they made a concession to see the patient at 7:30 a.m. this morning. This calmed the patient down, and made her feel like she was important enough to be heard. Patient seen, crisis averted.
Every insurance plan has some kind of caveat. Knowing these and maneuvering the maze of requirements takes skill, thought, and knowledge. What's important here is to make sure your staff are aware of policies and requirements, but can also make logical and helpful decisions that, while not violating those policies, complement them.