How your front office team members collect and handle insurance data makes a huge difference in whether claims are paid or denied. Even the tiniest error in data collection or data entry can result in delayed payment of claims or even complete denial of payment.
Consistent training and in-office organization are key to a well-run machine and the prevention of errors can be the difference between profit and loss. As the owner, it can mean the difference in paying yourself a fair salary and paying yourself a pittance.
Take a moment to review the statements below and put a check next to the ones that applies mostly to you. In the past 3 months:
Claims were denied for lack of authorization or lack of a referral.
Claims were denied for incorrect ID number or DOB.
We exceeded the number of authorized visits on a case.
Claims were denied due to incorrect insurance verification.
We had already seen a patient for several visits before realizing we needed authorization.
We identified insurance benefits incorrectly and all claims were denied.
I have no idea what is happening with my insurance collections because someone else is completely in charge of it.
If you put a check next to any of the statements above, then you’re losing money regularly due to errors and lack of proper training.
Let’s review several ways an untrained or disorganized front office can result in a failed billing cycle:
Being in a rush to collect patient demographics and not repeating back what you wrote down.
When you're in a hurry to gather the patient information because the phone is ringing or there are other tasks to do, errors will occur.
Also, if you don’t repeat back the data you collect, you'll also increase the risk for error.
Having a cluttered work area.
If the work area is cluttered with different tasks that still need to be done, or just overly disorganized, it causes distraction. With clutter and distraction, there will be a significant increase in errors.
Not verifying the insurance benefits in person.
When you verify insurance benefits though the automated phone or online system, you don’t always receive correct information, you only get some of the information necessary, or it doesn’t fully apply to outpatient PT in an office setting.
Don’t rely on the automated system for verification; instead call and speak with a representative.
Not reviewing the insurance card and ID.
You probably scan or photocopy insurance cards and ID but do you use them when entering data into the system?
If you don’t review the card and enter data directly from the card into the patient account and instead rely on what was written on the intake form, you're creating the potential for significant errors.
Not ensuring that the data entered is exact.
Reviewing the patient data that you entered into their online records is key to ensuring that you have it all correct. If you're in a hurry and enter one key piece of information incorrectly, it will cost you time and money when claims are denied and you need to make corrections and refile claims.
Not reviewing claims before sending them.
Reviewing claims before sending them ensures that all the information that should be on the claim is there and is accurate.
Of course, if it's all entered correctly before this step, you've already significantly reduced the risk of error-related denials.
No one checking patient accounts regularly to ensure proper timely payment of claims.
The sooner you know about a problem, the faster you can correct it.
Since ensuring patients receive the care they need is the primary responsibility of the Patient Care Coordinators, checking EOBs and accounts tends to get set aside until “I have some time” and that's a huge mistake. Not being aware of problems can significantly increase your errors and can result in huge financial losses in the long-run due to time spent trying to collect or complete denials of claims due to the errors.
So, what can you do to prevent common billing errors?
Have specific systems in place to ensure proper collection of patient demographics.
Have a set form that's used to collect demographic information when the potential patient calls to schedule.
Make sure that you repeat back to the caller the information you collected to verify it's correct.
Have a verification form that you fill out with specific questions that have to be asked for all insurances. This ensures that nothing is forgotten and everyone collects the same information when they call to verify.
Verify benefits in person not via an automated system.
Speak to an actual representative and make sure you get all of your questions answered. When you speak to someone, you're more likely to get better patient-related insurance data.
Speaking with someone on the phone will give you the best chance of finding out that a patient needs authorization or an insurance referral.
Make sure to tell them what you're calling about - outpatient physical therapy in an office setting - or they may give you the wrong data (this is what happens many times when we use the automated system).
Don’t be afraid to hang up and call back – if the person you are speaking to doesn’t answer your questions or doesn’t seem to understand what you’re asking, hang up and call back.
Have a set time of day to verify insurance benefits and when you sit down to do it, be prepared to focus on that. Distractions result in common errors.
Always copy the patient’s insurance card and ID.
Not only are you required to verify that your patient is who they say they are by looking at their ID, you should use it to ensure you enter the correct name spelling, address and DOB for the patient.
Entering the information off the insurance card also decreases risk for errors.
Check and double check before filing a claim.
First – check and double check the original data you entered when creating an account for the patient. Most claim denials occur from someone from errors in keying in basic patient data like name, DOB, insurance, insurance ID # or group number.
Also, make sure all the other data is correct like charges, amount billed, and if you have their primary and secondary insurances noted correctly.
Have a specific system to ensure proper payment of claims.
This action tends to get set aside, “until I have time”, so some patient records go months without being checked. When you regularly check a patient’s account you're more likely to find errors that can easily be corrected.
Each patients' account should be reviewed 2 weeks after the first claim is files, at 30 days and then every 30 days after that if it isn’t a problem case. Problem cases should be checked more regularly.
Handle any denials or errors IMMEDIATELY and stay on top of that patient's account to ensure there are no more surprises.
Track authorizations outside of your EMR.
Knowing when authorized visits run out helps to prevent a patient from accidentally going over their allowed visits.
Having a system to track patient authorizations will also give you more control over them and help you ensure that you're requesting more authorized visits in a timely fashion and patients won't have to wait.
As part of your verifications system, if you verbally verify if authorization is needed, you will prevent claims being denied for lack of authorizations.