As patients update coverage, who handles your insurance verification?

Note: MGMA does not endorse any solutions put forth by MGMA members on the specialty group email forums. We urge readers to explore the legal issues — federal, state and local — that might arise from a particular course of action.

The following excerpt highlights members’ advice on staffing for patient insurance verification in a medical practice. Read these and other discussions at community.mgma.com.

In your practices, do you have the employee who verifies insurances on a daily basis under your billing department or under your communications/scheduling department?

In my practice, it is billing staff. They also note on the superbill how much to collect for each visit. This would include applying any balance or credit on the account from previous visits and out-of-pocket expenses for upcoming appointments (copay, coinsurance, deductible). They also put in the remaining deductible for each patient.

They use most of the carriers’ websites directly (including Availity). For all others, including Medicare, we use a third-party vendor.

They verify three business days in advance. If someone schedules a same-day appointment, that person notifies billing.

For appointments greater than same day but less than three, the billing staff scans the schedule for any appointments that do not have a current verified date.

William “Bill” Hambsh, FACMPE, CPA, chief executive officer, North Florida Women’s Care, Tallahassee, Fla.

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We have two insurance verification specialists under the billing department umbrella. Same duties and responsibilities as Bill outlined earlier, with the exception of we verify insurance four days out. I created the position in 2014 and have since added another in the same position due to practice growth.

Steve Stout, MHA, administrator, APM&R, Ann Arbor, Mich.
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We use third-party software that verifies most insurances as a batch in about 10 minutes and can also verify on the fly.

Dena Merrill, administrator, Hill Country OB/GYN Associates PA, Austin, Texas, d.merrill@ahcobgyn.com
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We have medical secretaries who work in our call center — most are cross-trained to cover front desks when needed. Each physician (eight total) has a secretary assigned to her physician team (doctor, midlevel, nurse and secretary). All calls are answered by all the phone workers, but part of the secretary’s job is to look ahead at her doctor’s, physician assistant’s or midlevel’s schedule. We expect the secretaries will verify insurance eligibility, figure out whether it’s a copay or deductible, make a note about whether the deductible has been met so the front desk knows what to collect. They’re also reviewing the doctor’s day to make sure there’s sufficient time, and for follow-ups, they make sure that any testing or lab results are in the chart so the doctor can prep charts easily. The doctors have a go-to secretary to call their patients to relay information.

We do it this way because doing insurance eligibility all day long would quickly drive a person insane. Additionally, it gives the secretaries insight so they understand what’s happening every day with their doctor, which helps them know when and whether to ask about adding additional appointments or prioritizing calls from specific patients. And the patients quickly learn that they can communicate with their doctor and her secretary, especially quickly if they use the portal.

Jane Dodds, MPH, FACMPE, practice administrator, Women Gynecology & Childbirth Associates, P.C., Rochester, N.Y.
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Our group employs 11 physicians and six midlevel providers.
We operate out of three offices as well as staff a 35-bed rehabilitation unit at our affiliate hospital. Additionally, we also contract with five skilled nursing facilities and rehab centers in the joining communities.

Two FTEs [full-time-equivalents] are responsible for insurance verification on roughly 100 to 140 charts per day (checked four days in advance), as well as a few other responsibilities within our billing department. Insurance is verified, and copays and deductible amounts are also written on each encounter form to be collected at the time of service.

This responsibility was once spread out as a standard duty within the billing department; however, we’ve become far too busy and our accounts receivable (A/R) and collections were starting to slip. With the addition of this position, our A/R is now typically outperforming MGMA standards.

Steve Stout
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The patient account representative (a member of the billing team) checks for the birth control, office procedures, and global and surgery benefits. The front desk will sometimes call on birth control if she’s backed up or if we decide to perform an unscheduled procedure. Otherwise, she calls the insurance, then notes in the patient chart all the details. If it is for OB or surgery, she will call patients to let them know the details.

Crystal Miner, MBA, FACMPE, practice administrator, Denali OB/GYN Clinic, Anchorage, Alaska, crystallminer@gmail.com