Top 5 Ways to Amend Patient Collection

February 27, 2015

Patient collection is a string of various processes which starts at the time of making an appointment with the doctor to completion of collecting the entire charges for the offered services. Every step in the process is vital because a slip even in one step might result in stagnation or less revenue.

These are the top five ways to amend patient collection:

  1. Pre-visit Verification
    Verifying the insurance that covers the patient prior to the scheduled visit is important. The basic information about the coverage can be obtained through the web services provided by the payer but there are limitations when it comes to information about the co-pay eligibility and covered criteria. These are difficult to obtain because they vary depending on the services sought by the patient. A direct communication with the payer over the phone helps in resolving the issue to a greater extent. This will also avoid getting into payer underpayment issues.
  2. Clarity about the Insurance
    The American Medical Association (AMA) released the 2015 CPT code changes which came into effect on January 1, 2015. The Centers for Medicare and Medicaid (CMS) has already released the Medicare values for these new codes as part of the 2015 Medicare Physician Fee Schedule (MPFS) Final Rule.
    Filing the insurance claims in the right order is important to avoid denials. Particularly in the case of dependants, where the birthday rule comes into play or in Medicare where the secondary player enters the process and with spousal coverage, such clear understanding is absolutely necessary.
  3. Purpose of the Visit
    Understanding and documenting the exact purpose of visit would help in many ways during the collections process. If the visit is for certain basic examination or to have the blood tested, then these services may not come under co-pay schemes as insurance companies offer some services as free benefits to their customers. This step is mandatory during the check-in time of the patient and avoiding payer underpayments.
  4. Co-pay Liabilities and Exemptions
    The routine physical examinations and health check-ups for children may not come under deductible liability. Almost all insurance companies offer global packages and they include pre-operative check-ups and post-operative care. The co-pay claims are not required in these cases and the complete expenses incurred could be claimed from the insurance companies.
    The period of pre and post-operative check-ups might vary depending upon the seriousness of the illness and the kind of surgery that is carried out. Some awareness programs like diabetes management also are waived from the co-payment category by the insurance companies. There could be secondary plans covering the patient within the actual insurance and getting a clear idea about them is also essential.
  5. Time of Collection
    The purpose of visit of the patient might change after the physical examination of the provider. The reason could be as simple as the patient did not reveal the entire history or the provider diagnosed a different ailment. This scenario might change the co-pay amount and also the claims process. Considering the prevailing conditions in the office of the provider, it would be advantageous to plan the co-payments immediately after visit of the patient.

Category : Revenue Cycle Management