The Patients Access plays a very important role in capturing and collection of patient service revenue. Patients Access and a Successful Revenue Cycle Management The Patients Access plays a very important role in capturing and collection of patient service revenue. There are 3 parts of Revenue Cycle where the Patient Access Management is very important and the Patient Access Team plays a very valuable role. 1. Pre-service Phase
2. Time of Service
3. Post-service Phase
Focusing on Customer Service and Patient Satisfaction is very important. Customer Service and Patient Satisfaction 1. Treating patient with respect and dignity 2. Treating patient as you would want to be treated 3. Communicating in a manner the patient can easily understand 4. Value your patient's time and focus on efficiency 5. Show empathy to your patient What pieces of information do we gather:
Additional Useful information that you can also gather from the patient:
So what's next after obtaining all the necessary information? 1. Patient access team member must start confirming coverage for the patient 2. Verify if the provider is in-network or out-of-network with the patient's plan 3. Check eligibility if the patient is eligible for coverage on the date of service 4. Ask the patient if they have a secondary insurance coverage 5. Complete clarifying the benefits for services with the insurance company 6. Check the patient's copayment or any co-responsibility and if the patient has an out of pocket amount that has to be met (family or individual 7. You can ask the insurance company for specific benefits for specific services. I always suggest giving insurance company specific CPT code(s) or Diagnosis code(s) if available - document everything 8. Collect the copay at the time of service if you are contracted with the patient's insurance plan; 9. Verify if there is a deductible or coinsurance and how much have been met, you can collect them at the time of service as well 10. Make sure you be knowledgeable enough on how to answer the patient about their concern and questions about their copay or any other co-responsibility. Let's look at how the Patient Access team verifies patient who has a Medicaid Coverage: Viewing a patient's ID card alone does not ensure their Medicaid eligibility, nor does having a referral or pre-certification on file. As a member of the Patient Access team, insurance can be verified during pre-service or on the date of service. It is imperative in my opinion that the Patient Access team must verify eligibility during the MONTH that patient is scheduled to be seen or is coming for service. Because their coverage may always change. If you fail to verify eligibility, there is a very high risk of claim denial for sure. Possible scenarios? the patient may not be eligible at the time of service, or the HMO was not contracted with your practice at that time of service. Result? claim may not get paid. Resulting in lose of revenue. What happens if we did not correctly verify the patient identity?
About 40% of data used for revenue cycle management are gathered by Patients Access Teams. About 40% of data used for revenue cycle management are gathered by Patients Access Teams. Mistakes and errors will greatly affect the billing and coding process thus causing payments delay. Delayed reimbursement will significantly affect your cash flow. Patients satisfaction, prompt payments are the best results of your high quality customer service and are all based on how good your team with their communication skills.
0 Comments
Your comment will be posted after it is approved.
Leave a Reply. |
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio, MSC, CSPPM, CRCR, CSBI, CSPR is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant. Current HFMA Professional Expertise Credentials: HFMA Certified Specialist in Physician Practice Management (CSPPM) HFMA Certified Specialist in Revenue Cycle Management (CRCR) HFMA Certified Specialist Payment & Reimbursement (CSPR) HFMA Certified Specialist in Business Intelligence (CSBI) search hereArchives
August 2024
Categories
All
BROWSE HERE
All
|