Understanding Patient`s Eligibility, Co-pays, Co-Insurance, Deductibles and Past Due Balances 2023 Changes
STEPHANIE THOMAS, CPC CANPC
Objectives
• Information
• Understanding
• Implementation
•
• Tips,
• Patient
• Q&A
• What is patient eligibility?
obtained during checks
eligibility reports
of processes
Preauthorization and referrals
checklists, common errors
involvement
Insurance Verification ▪ Call or check online (Availity, direct on payer site) ▪ Most PM Software can check right from the patient demographic page ▪This tells you if the patient is eligible and if the information you have is accurate
Demographic Information ▪Verify these at every visit ▪Obtain Social Security Numbers whenever possible Obtain the correct ▪patient address ▪phone number These are the KEY to getting you paid! Copies of insurance cardskeep current! Don’t delete old cards!
are we looking for??? 1. Is patient eligible for this date of service 2. Current benefits a. Deductible b. Copays c. Coinsurance 3. Any HMO coverage (Medicare and Medicaid patients) 4. Any other coverage (issues with COB)
What
Referrals and Pre-authorization
▪ Tricare, Medicaid plans, even some BC plans require this even on the first visit! ▪ Most plans require authorization for testing and procedures. ▪ Inquire on every patient, every time.
common problems oThird party administrators-entered incorrectly o Southwest Service Administrators o Multiplan o First Health o Teamcare oIncorrect payer ID’s or identifiers in software oSubscriber info, relation oAllowing system to “auto-check”-be sure to review results!
Other
Collection of Patient Responsibility
▪ Be sure your staff collects co pays, coinsurance amounts, deductibles and past due balances every visit.
▪ When calling/checking for insurance verification this information is typically given.
▪ It is recommended to provide this information to the patient when calling to remind them of their appointment the day prior, so they are prepared to pay.
Identify Denial Trends Quickly ▪ Have an open and close relationship with your billing department ▪ It is recommended to have monthly meetings to review denials and claim issues seen due to eligibility referrals and authorizations
Prepare Copay/Collection Log
Checklist for eligibility and patient account success! ➢Payer websites working ➢Availity ➢UHC Online ➢Local MAC ➢State Medicaid ➢One Health Port ➢BCBS (if not through Availity) ➢PM software set up properly to run eligibility AT LEAST 2 days prior ➢Prep work for copay/collection log (training or obtain from billing team) ➢Training/help sites for when eligibility function is not working properly ➢Coverage plan for vacations/sick
Questions?
Stephanie Thomas CPC CANPC stephanie@elitecodingandbilling.com