remember the phone game? a group of children sit in a circle, and then someone presents a message and whispers it to the person to their right. that person whispers what they heard to the next person, who then whispers it to the next person, and the message travels around the circle until the last person announces what they heard. somehow, almost always, the message gets twisted and distorted until something like “hockey is cool” becomes “the pig monkeys rule”.
It may sound a bit silly, but getting the right patient insurance information can feel uncomfortably similar to a game of telephone. a patient’s employer tells the patient about their insurance plan, the patient tells you, and then uses this information when submitting a claim to the payer, except, whoops, the information the payer has on file doesn’t match with their records, and suddenly you’re stuck in the city of denial. The best way to avoid this high-stakes phone game is simply to immediately verify the information your patients give you. So, let’s review how to verify insurance benefits.
Reading: How to do insurance verification
1. collect the patient’s insurance information.
First things first: If you want to avoid pass denials, you need to get some information from the patient as soon as possible. Verifying insurance isn’t always easy, so allow plenty of time to complete this process, which means asking new patients for their insurance information when they call to make their first appointment. When collecting patient insurance information, be sure to record:
- patient name and date of birth;
- the name of the insurance company;
- the name of the primary insurance plan holder and their relationship to the patient;
- the patient’s policy number and group identification number (if applicable); and
- the phone number and address of the insurance company.
- united health
- Can you confirm the patient’s policy and group number, policy holder’s name and policy holder’s relationship to the patient?
- Can you confirm your claims address?
- Is this policy active, and if so, what is its end date?
- How many therapy visits does the patient have left this year?
- what is the patient’s copay and/or coinsurance?
- what is the patient’s deductible?
- do you need medical referrals, prior authorizations or certificates of medical necessity for reimbursement?
- Are there any coverage limitations or documentation requirements I should be aware of?
- Is the therapist the patient plans to see in or out of network?
Don’t forget to ask about secondary insurance! if the patient has other policies, she will need to complete all of these steps for each.
2. contact the insurance company prior to the patient’s initial visit.
The main reason you should start the verification process earlier is that it may take some time to complete this second step. you could be sitting on the phone for about 20 minutes, and that’s with a relatively easy verification process. for this reason, we recommend initiating contact with payers at least 72 hours prior to the patient’s initial visit. this will ensure you have all the information you need long before the patient walks through your doors.
contact by phone
The most common way to communicate with payers (and, by the way, the most time consuming) is by phone. simply get the information you received from your patient, find the phone number of the insurance company and dial. once you call someone on the phone, make sure you’re talking to a representative on the provider’s service line, as some payers have lines exclusively for hospital admissions or referrals. After confirming that you are speaking with the correct representative, this resource says that you will need to provide some information about their practice to confirm that it is a secure HIPAA exchange. Finally, the representative will ask you to provide some of the patient’s information (usually the patient’s name, date of birth, and policy number) so that he or she can locate the correct policy.
If you’re having trouble reaching a representative by phone, try calling back at a different time of day or day of the week. The provider service line is like any other customer help line; there will be busier hours (and even days) when more people tend to call at the same time. (tip: avoid the Monday morning rush!)
If you don’t like the idea of playing payer phone tag (totally fair), you can opt out of telecommunications altogether by searching Payer’s online eligibility verification resources. There is no gold standard with these resources, and you may need to scroll through search directories or submit question forms, but you should be able to find the information you need somewhere on the payer’s website. here are some starting points for some common payers:
Warning: Provider directories provided by payers are known to contain outdated information. this might not necessarily be the case for eligibility resources, but it doesn’t hurt to be cautious and aware of the possibility.
implement automatic verification services
For those who prefer to skip payer wait times and convoluted website routes, we don’t blame you, there are digital solutions available to help you automatically verify patient benefits. While you’ll likely have to pay for these services, they can be worth their weight in gold, especially when integrated into an EMR. Instead of sitting on the phone for hours or browsing outdated websites, front desk staff can click a button, verify insurance in seconds, and spend the rest of their time on their other tasks.
webpt ebenefit verification saves rehabilitation therapy practices time by quickly verifying a patient’s insurance benefits electronically in webpt emr and putting that information directly into the patient’s record, thus eliminating the need for lengthy phone calls and time waiting with insurance companies.
eliminate verification headaches before they even happen, and before you even have to open the aspirin.
3. gather all crucial benefit information and record it in your emr.
Now that you have the payer representative on the line (or the eligibility information on the screen), it’s time to prepare your checklist and gather the details you need to know that will help you avoid claim denials. here’s a list of questions (compiled from the lists found in this post, this post, and this post) you can ask that should cover most of the information you need to record:
Please note, however, that this list is not necessarily the end of all insurance verification questions. Perhaps questions have come up at your clinic in the past about a particular payer’s strange rule (e.g., does it apply to this specific policy?), and now is the perfect time to seek your answers!
Assuming everything went smoothly with your information gathering, it’s time to record the necessary information in your emr. and after that, you’re done! At this point, you need to know whether or not the new patient has a valid policy, along with a general estimate of how much the patient’s visit will cost. If you really want to knock your customer service out of the park, call the patient back to provide them with an estimated copay; It’s a great way to earn some goodwill! When the patient finally shows up for their first appointment, be sure to scan the patient’s insurance card (and photo ID, if possible). If you ever need to confirm information about the patient’s policy, you can immediately reference the scan, and you won’t have to bother the patient about it!
extra step: check again every month.
In a perfect world, patients would remember to let you know the moment their insurance changes. But patients also have a lot on their plates, and if their insurance plan is changing due to something like birth, adoption, marriage, divorce, or a change in employment, they may forget to keep the office informed. your therapist’s main As such, it’s a good idea to re-verify your patients’ insurance plans regularly, monthly if possible.
Telephone play can be a fun way to teach kids to be wary of second- and third-hand information, but it’s no fun when the facts they misremember affect their work lives. Insurance verification can be time consuming and tedious, but it really is the best way to avoid major billing issues.
See also: AARP Health Insurance | Insure.com