Palmetto State News 2018-2019 Issue 1 - Page 10

The revenue cycle begins with patient-facing tasks that have a huge impact on back-end claims management and reimbursement. One of the most critical front-end responsibilities is determining eligibility. It lays the groundwork for billing and collecting claims in the most efficient and effective manner possible by helping to prevent claim denials on the back-end.

Here are the top five eligibility best practices for improving revenue cycle management:

1. Always ask to see insurance card and run eligibility checks at the registration desk. Too often registration staff either fail to ask for insurance, or simply assumes prior coverage is still active. This misstep leads to an unnecessary, costly increase in self-pay accounts, or an increase in denials and additional collection costs. Each result leads to an increased workload for staff post-service.

2. Train staff to properly read eligibility responses. Many times patient representatives add a policy to a patient account, and that policy doesn't carry the benefits needed for a procedure. Training staff on how to correctly read eligibility responses is crucial. In addition, an eligibility platform that displays information in a format that is easy for staff to view supports this effort.

Failing to read/understand eligibility responses properly has a negative and sometimes costly impact on point-of-service collections (co-pay, co-insurance and deductibles). A well-trained staff can more confidently ask for payment at the time of service, without jeopardizing the patient relationship.

3. Utilize an eligibility provider that also provides insurance discovery.

Utilizing an insurance discovery platform will locate any insurance coverages missed at registration, as well as any retro-approved coverages.

Use insurance discovery to save money by not having to pay an early-out vendor or collection agency because you found eligible insurance coverage instead of them. What’s more, insurance discovery can actually earn money by capturing accounts before they reach filing time limits and frees up financial counselors so they can focus on accounts in need of their assistance.

4. Train staff to review patient financial responsibility when viewing eligibility response. Collecting co-pays, deductibles, and co-insurance prior to discharge impacts all areas of the revenue cycle. Staff’s abilities to read responses correctly and collect patient responsibilities are equally important.


Top 5 Eligibility

Best Practices

Brad Skelton, HFMI Regional Manager