Reduce Unpaid Claims before Patients Visit Your Medical Practice

February 25, 2012
P.J. Cloud-Moulds

By taking a few moments prior to a patient's appointment, you are investing in the success of your medical practice.

We've all heard, and most likely used, the saying, “Garbage in, garbage out.” This applies to so very many areas in our lives. I'd like to focus on the area in your medical practice where if this saying is followed, will directly result in unpaid insurance claims.

I'm talking about the moment a patient calls in to make an appointment. Even if they are a current patient of yours, how much time is spent up front making sure that if the patient is going to be using some type of medical insurance, that you accept it or are out-of-network with it, have verified that it is still active, or that it will pay the CPT code used? I know when the phone is ringing, and your staff is trying to schedule a patient, and collect a co-pay, these things are missed, completely in some cases. Your staff is taking a gamble with your business when this occurs.

Here are some guidelines you can use, starting today:

When a patient calls to make an appointment, be sure your staff is doing the following:

1. Confirming that the patient (if it is a returning patient) still lives at the same address and confirming the phone number and date of birth. If it is a new patient, obtain all of this demographic information.

2. Asking if the patient will be using medical insurance and what it is, being sure they get all ID numbers from the card (or medpay / work comp claim), as well as the provider or contact name number located on the back of the card.

3. Based upon your offices policy, if any paperwork needs to be updated in your software system prior to the appointment, ask the patient if you can e-mail or fax it in advance or if they would rather arrive 15 minutes early to go over this paperwork.

Once off of the phone and the appointment has been scheduled:

1. Your staff can call up or go online to the insurance company website and obtain all of the benefits including: deductible (if any), co-pay or co-insurance, out-of-pocket amounts, if any authorization is needed, and if there are limitations to the policy (i.e., pre-existing conditions, etc.).

2. Once this has been obtained, be sure your system is updated with all of the information so that your billing department has access to it.

When the patient arrives:

1. Have a member of your staff sit down with the patient and go over their benefits. This is a critical step in making sure the communication between your practice and your patients is clear and up front. Oftentimes, patients will receive a bill (that goes unpaid) because they do not understand their insurance benefits, and “no one told me that I would owe anything.”

2. You can write these up on a form that you hand to the patient (a photocopy) after they signed it stating they understand their insurance benefits and these have been explained to them. This, alone, puts the accountability back on the patient where it belongs. Remember that you are billing the patient's insurance as a courtesy to them. You are not required to perform this administrative function for them, but because you want to help them out and get them feeling better, you took on this cost and responsibility for them.

3. Collect any co-pay, coinsurance, or deductible based upon the contracted rate that you have with the patient's insurance (this can be done at the end of the appointment based upon how you code).

I know it seems like a lot of extra work, but when you are looking at your aging accounts receivable and see it creeping away unpaid, these 15 minutes of time up front are well worth the investment versus not getting paid.

Next week, we will discuss gathering your contracted rates and allowed amounts into one form, and how this will increase your inflow immediately.

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