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Medical Group Management Association

5 simple steps to help medical groups avoid costly billing mistakes, improve revenue capture and reduce patient anxiety

Insight Article - February 7, 2022

Medicare Payment Policies

Quality & Patient Experience

Billing & Collections

Reimbursement

Business Operations Technology

Steve Wirth Esq., EMT-P
Juli Forde Smith
When providing healthcare services, we are entrusted with the care of vulnerable patients. Patients are medically vulnerable, meaning that they often come to providers with significant and potentially life-threatening conditions and are relying on others to make appropriate medical interventions on their behalf. At the same time, patients are also financially vulnerable, meaning that they are not always in a position to confirm that a provider is in-network or to review the financial considerations before care is provided.

While it’s the patient’s responsibility to provide accurate information, they don’t always arrive with everything in hand. Especially in emergent situations, patients whose primary concern is receiving the medical care they need are not thinking about their Social Security number, their Medicare card or their current insurance ID card. This can put provider and patient at a disadvantage when it’s time to bill. 

Healthcare services are expensive, and errors and omissions that we, as healthcare providers, make in information gathering, documentation and billing can cost the patient significant out-of-pocket dollars that should not be their responsibility. Medical debt is one of the most common reasons that people file for bankruptcy, and we have a professional responsibility — and an ethical duty — to make sure we provide medically necessary services that are well-documented and billed to the proper payer for the proper amount. The goal always should be to provide our patients with the highest level of care with their medical and financial vulnerabilities in mind.  

We can reduce the patient’s financial vulnerability by following five simple steps that can help keep the patient from getting stuck with a large out-of-pocket expense. These steps can also help ensure you obtain the maximum (and proper) reimbursement available for the services you provide. 

1. Obtain patient information at time of service 

You should capture as much patient demographic and insurance information as you possibly can at the time of service and as early in the patient encounter as is reasonably possible. This means getting the correct spelling of the patient’s name, address, social security number, cell phone number and insurance information whenever possible. On occasions when a patient is not completely forthcoming, staff must be trained and ready to respectfully and assertively reiterate the urgency of obtaining accurate information. 

2. Follow the patient signature rules 

Medicare and insurance companies require that the patient sign an assignment of benefits (AOB) statement that assigns payment under the patient’s benefits plan to the healthcare organization providing the patient care. This form may also provide patient consent for care language. 

Without a proper AOB signature on file, it may be impossible to submit the claim for patient services to the proper payer. The bill for your services may then need to be sent to the patient, which can create a lot of anxiety for the patient. In most cases, there are exceptions to obtaining the actual patient signature when they are physically or mentally incapable of signing. In those situations, a representative of the patient may sign on their behalf. 

3. Determine who is responsible to pay 

There are various rules as to who is responsible for payment of the claim for medical services.  If the patient is covered by Medicare, Medicaid or has health insurance, then the insurer is the proper payer. Insurance discovery technology finds all billable coverage options in real time and prevents misidentification of expired coverage and misclassification of patients as self-pay. Insurance discovery also identifies charitable options, including Medicaid. Identifying which payer should be billed and getting it right the first time can save time, reduce days in accounts receivable and avoid the distress that comes when payment is outstanding and the patient gets billed unnecessarily. 

4. Know your patient’s insurance profile 

Revenue cycle technology provides many options for electronically searching the patient’s profile to obtain current and up-to-date insurance information, such as automated insurance verification. Too often, staff members are uncomfortable asking the patient for the information mentioned in Step 1, passing the responsibility downstream without understanding the headache being created for the patient and provider. Demographic and insurance verification tools can help ensure that these essential data points and coverage are complete and current, often correcting or enhancing more than 60% of the core demographic information needed to file a clean claim.

We’ve seen many claims denied simply because of a minor transpositional error or minor discrepancy in patient demographic or insurance information. Healthcare providers who do not pay attention to these important details create distress for the patient and reduce the likelihood of getting paid properly and on a timely basis. 

5. Practice “right-day billing” 

The patient accounting practice of the past was to get the bill out as soon as possible after services were provided to reduce the time it takes to get reimbursed. That is no longer the case in this era of high-deductible insurance plans. Healthcare providers must practice deductible monitoring to ensure that the claims submitted are properly timed so that your services are less likely to be consumed by the deductible, making it the patient’s responsibility to pay the claim out of pocket. Sometimes, chasing down self-pay accounts is incredibly challenging. The good news is that deductible monitoring technology makes this process painless and very effective.

There are many good revenue cycle software programs for healthcare organizations that can quickly and accurately identify patient insurance and determine the likelihood that you will be paid. Timing the bill to go out on the “right day” after deductibles are met can improve billing efficiency, reduce your costs and significantly increase your revenue. As an added advantage, it will also prevent undue anxiety for the patient. 

By following these five simple and commonsense approaches, your organization can reduce the patient’s anxiety about the cost of services and keep their financial vulnerability in check.
 

About the Authors

Steve Wirth Esq., EMT-P
Founding Partner Page, Wolfberg & Wirth, LLC

Juli Forde Smith
Director of Strategic Partnerships ZOLL® Data Systems
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