• Happy Patient, Happy Practice

    Nothing is as frustrating to patients who have received exceptional care in the office as receiving a bill for medical services they thought were covered.

    Whether it is a billing error or lack of benefit, here are five useful tips to avoid claim denials and keep patients happy through the entire process of their care.

    1. Gather and verify all the necessary information.
      Train staff who schedule appointments and complete registration to double check the spelling of patients’ names and ensure that they match insurance cards. Enter the correct dates of birth and policy ID numbers. Ask patients why they are booking an appointment. Medical verses routine eye care is a blurry line, and confirming the type of appointment prior to visits helps set expectations for care.

    2. Verify coverage and confer with patients.
      Do you participate with the presented insurance and do patients have active coverage for the date of service? Pull benefits and payer coverage policies to identify potential out-of-pocket expenses for which patients may be responsible. Knowing if anticipated care will be covered and having responsibility conversations ahead of the office visit eliminates heated encounters at checkout or reactions to patient responsibility.

    3. Review documentation and coding carefully.
      A billing mistake made by the practice may be shared with patients via explanation of benefit or remittance advice from their carrier. Mistakes can reflect poorly on you and cause patients to lose faith in the practice. Offer documentation and coding training to all staff, ensuring accuracy and efficiency, profitability and protection from recoupment.

    4. Submit claims in a timely manner.
      Chart notes should be completed within 24 hours of the patients’ visits. Initial claims to the payer should be processed within the same week. If rejections or denials occur, resolve them daily. Unresolved denied claims may be forgotten and exceed timely filing deadlines. Outstanding claims affect practice revenue and untimely resolution may prompt patient questions when they receive a statement for their balance.

    5. Focus on the patients.
      Understanding insurance benefits can be difficult for all parties.Remember that ophthalmic staff are well-versed in eye care fundamentals. Patients may be experiencing eye health needs for the first time. Do not assume they understand how their benefits work. Educate them at each step of their encounter, from scheduling to final payment.