By Georgina Perry, CPA, CMPE
Recently I have had conversations with clients about how hard it is to make the most of the revenue generated and keep the loyal but burned-out staff engaged so the practice can survive to work another day. Recovery from COVID for small businesses has been tough, but especially in healthcare where the demand for service remained high during the pandemic. Now, medical practices are looking to make the most of the revenue they can generate without overwhelming current employees. With that in mind, it’s time to work smarter, not harder.
Start by reviewing how the patient visits begins, the check-in process. Best practices would include offering patients an online option to complete the intake and demographic information at their convenience prior to the day of the appointment. This also allows for review and verification of information and insurance coverage prior to the appointment.
In addition to this process, tablets in the waiting room should be available to patients to complete the online information on site the day of the appointment. This doesn’t allow as much lead time to confirm and verify information prior to the visit but it does save the intake staff from having to retype the patient information into the EMR, if your EMR allows for direct integration. When online data collection is not available, the patient intake form should be created to mirror the screens the intake staff will complete in the EMR. This allows for the most efficient input of the patient information.
Staff should run insurance eligibility for patients two to three days prior to the appointment to allow for human intervention when errors or issues occur. Most EMRs can run this report at night automatically. Staff should also use summary insurance information to confirm if any prior authorizations or other limitations exist. Patients with expired insurance on file should be flagged for staff to request updated insurance information before check-in. Going the extra mile to make sure patient insurance information is correct could save valuable hours and dollars correcting claims and chasing down patients.
Not only should your staff confirm insurance is active, but also note the copay and deductible in the EMR where it is visible at check-in. Most EMRs have a place to record the copay amount in the patient demographics screens. Usually, this copay amount requires manual review and entry but it proves to be helpful at check-in for a quick reference and collection. If the insurance summary shows the patient has not met their deductible, it is important to have a policy in place for collecting some portion of the actual or estimated charges the day of service. While noting amounts to collect, staff should confirm if any old balances are outstanding and collect those as well.
It is vital that make sure all the requisite information is correct during the patient’s initial intake to reduce denied claims and to save the time required for insurance staff to correct claims later on. When patients are able to register online, staff can verify insurance prior to the visit. Once the patient arrives, they should pay their copay while staff checks their account for any balance that may need to be collected as well. Using these best practices allows for a reduced denial rate, an increase of balance collections and less staff time spent on claim corrections.
Georgina Perry, CPA, CMPE serves as Director of Physician Services at Carr, Riggs & Ingram.
