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Patient Payments Blog

Secrets To Find the Needles in the Haystack: Patient Eligibility Verification Tips

Posted by Shawn Smith

Oct 7, 2015 10:00:00 AM

It used to be enough to perform a patient eligibility verification check once per plan year, but now the best practice is once per calendar month. This increased frequency is because there are a growing number of patients transitioning between insurance carriers more often. How can you keep up with this best practice and find the most important "needles in the haystack" who require updated information without burdening your front-office staff with hours of searching?

Move on from the red/green eligibility tools of the past. Their lack of filtering capabilities make it impossible to deliver complex information needed to determine coverage issues. What practices need is a tool that helps them better know their customer and ultimately helps the eligibility team and financial counselor.

Following are some of the common “needles” we find providers need to filter for.

Narrow networks
While it used to be enough to be contracted with an insurance payer, now it is critical to understand which narrow networks you are allowed to participate in. If you don’t do your due diligence and end up treating a patient out of their network, the patient inevitably will blame you. And in many cases you’ll never see the money owed. Protect yourself with an eligibility tool that dissects the haystack of patients and finds the few key patients who require narrow networks.

Was that a D or a B?
It is incredibly easy to transpose a digit or enter a patient's name incorrectly. Your eligibility tool should quickly flag these patients out of the haystack and allow quick tools to adjust data, retry and correct errors. Your chosen tool also needs critical EMR data at the eligibility team's fingertips like the patient's phone number so they can reach out when needed to correct a mistake long before the patient arrives at the practice.

Primary care physicians
Many insurance plans require a primary care physician (PCP) must be the named PCP with the insurer to guarantee payment. Specialists are burdened with making sure referrals are correct for the patient’s PCP. The first task is filtering the haystack of patients to even find the ones who have a PCP on file. Then you must identify which patients don't have a PCP on file that works at your practice. Your eligibility tool should quickly flag these patients out of the haystack for immediate attention.

Coordination of benefits
Coordination of benefits (COB) can be a frustrating part of treating Medicare patients and patients who have secondary coverage. Again, you need easy-to-use solutions to help you filter through your haystack of patients and discover which ones have a COB on file. It is important to check for updates every single time. It might be a small population on a daily basis, but one missed opportunity can make a huge difference in the time it takes to get a final patient responsibility and correct claim filed.

Copay or financial counseling
These days you must divide patients into two categories: those who have a copay and those who may need to have a conversation with you internal financial for the visit. It's amazing how effective a quick discussion on visit cost, and the offer of a payment plan or card on file solution can be to increase collections. Knowing this information will help you identify the patients with the largest financial liability so you can call and have a conversation days before they visit the practice.

The right tool

Easy Pay Solutions and Wellero have partnered to offer medical providers an efficient way to improve patient collections and to save front-office staff time and resources. Wellero is the eligibility tool that helps you sort the most important needles out of the haystack in all of these instances. Wellero is very excited to partner with Easy Pay because it allows us to give medical providers a lower credit card transaction rate, and the ability to promote technology-based best practices for effective billing and payment. We are looking forward to helping Easy Pay’s providers enhance their billing practices, leading to more revenue and more satisfied patients.

 

To learn more about the Wellero and Easy Pay partnership, visit this link

And if you haven't read our comprehensive Card on File guide yet, you can download a copy by clicking below. Uncover how the Easy Pay solution is more than just a technology platform, it's a methodology for solving patient bad debt.

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