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Insurance & Authorizations

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Michelle1965:
As we all know in Medical Billing it starts at the front end in regards to collecting patient demographics, insurance, getting authorizations etc...  My question is as a Billing Company doing the billing for the provider's office if the provider's front staff doesn't get the proper insurance from the patient upfront, and verify their benefits, and get the authorizations etc.... what do you do?   
I actually work in a provider's office right now in the billing department, and have come across so many errors where the staff doesn't get the correct information, and at this point the patient was already seen.  This creates a problem especially when its a HMO plan and you need prior authorizations/referrals. I have contacted the insurances before to try and get the auth after the fact, and they wouldn't retroactive the auth.  They have lost revenue, because of these mistakes! 
If I start my own Billing Company can I put in the contract that if their front end staff doesn't get all of the proper information from the patient at the time of the visit, then any lost revenue due to this wouldn't be my companies fault?  Especially for prior authorizations, because by the time I would get their charge entry slips/superbills it would be to late , because at that point the patient has already been seen!  There wouldn't be anything I could do, unless there was a way for me to get the info before the patient comes in for their appointment, then I could do the verifying, and getting the authorizations myself (of course that would have to be included in my fee as well).  Any advice in this area would be greatly appreciated!  :)

PMRNC:
I have my clients use a pre-screening form, this gathers all the information we need at the time the patient makes the appt. I do authorizations because it just makes sense that whomever does verification of benefits can get the intial auth right there on the spot in most cases.
By time patient comes in for their visit the pre-auth and benefit verification and eligibility check has been done. If an auth needs clinical info I send back a form to the staff and the claim is marked incomplete. Once a week I give each client a report of incomplete claims.

kristin:
This by far the most frustrating issue I run across when doing billing for other offices. At my office, I do everything involving the billing, so I have no one but myself to blame if a mistake happens. And they rarely do, because I am very, very careful.

But for the remote work I do, it is a constant battle getting proper demos, auths, etc. I am at the mercy of various staff from offices, hospitals, and nursing homes who either don't do things correctly, don't know how to, or don't care to. I have made various forms like the one Linda mentioned for staff to fill out, I have spoken to the doctors and their staff, I have called the hospitals and nursing homes, and still find lots of errors.

So you can either be proactive, or reactive when it comes to this. Proactively give them forms ahead of time, and/or do the demo entry and auths and verifications yourself. Or be reactive, and when claims deny because you were given bad info, correct them on the back end. Proactive is the way to go, but it is easier said then done, as I have discovered over the years...so I find myself being reactive more than I would like to be, unfortunately.

Michelle1965:
Thank you so much Ladies for your view on this subject. I like the pre-screening idea, but I agree it probably is easier said then done! In this case of when you have to be reactive do you include this in the pricing of your fee, because in my personal opinion when your having to correct so many mistakes of other staff members it keeps you from doing a lot of the important things like follow-up etc... 
I'm just an employee right now for a provider, and have mentioned this to the practice administrator several times, and she says to me its not going to change, because we have talked to the staff before about this.
I think if the provider had to pay a fee for errors made from their front staff not doing their job correctly, then they would definitely find a solution to the problem.  I totally agree this is the frustrating part as a Biller, and right now I can't change anything where I work, because they aren't listening to my advice, so I spend about 3 hours a day making corrections from other staff members  >:(, and they wonder why the A/R looks the way it does!  ::)

PMRNC:

--- Quote ---I think if the provider had to pay a fee for errors made from their front staff not doing their job correctly, then they would definitely find a solution to the problem.  I totally agree this is the frustrating part as a Biller, and right now I can't change anything where I work, because they aren't listening to my advice, so I spend about 3 hours a day making corrections from other staff members  >:(, and they wonder why the A/R looks the way it does!  ::)
--- End quote ---

You could ask for a raise  :P ??? ;D  Go the extra mile and so some reports to show how much they are losing. Save them money and ask for a raise. I would :)

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