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Insurance & Authorizations

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Merry:
In the "old days" about 25 yrs ago, I would charge the provider if I had to return a claim for insufficient info.  I charged 25 cents.  First bill was $147. All claims submitted after that were always complete.

kristin:
For my part, because I don't have a billing company, and am paid hourly for what I do as a subcontractor/employee, I get paid to fix all the mistakes I find, regardless. But if I DID have a billing company, I would absolutely factor this into my fee. Which is why percentage billing is not the way to go, because you won't recoup the effort you put in, when it comes to stuff like this.

I agree with Linda...while you are still an employee at your current job, show them how their staff is costing them money, and how you can increase their revenue. And get a raise for your efforts!

jennifer8055:
I had this issue when I started working at my current job.  The providers office had never verified patients insurance prior to their first appointment.  If they had not been in for awhile, they didn't verify to see if that insurance was still active.  I showed them how much we were having to "eat" because having to write off charges for services that had no authorization or referral because the patient didn't give us correct information.  You bill a claim - usual 7-14 day turnaround time for electronic claims to process...get a denial for "no authorization" - but now you can't get the auth because you only have 72 hours to get a retro-auth......you have to write off. 

Every where I had worked previously, we called the patients insurance and verified all benefits and even specific CPT/HCPCS codes that we may do, we do that here now.  For new patients, we get their insurance information when their appointment is scheduled and we have two girls that do nothing but insurance verification.  We have a standardized form that they use for every patient with in office procedure codes that could and DME codes that we could issue and we find out on the front end if those are covered, what the benefit is and if any precert/authorization is required.  Being a specialist office - it's imperative that we have these benefits verified because sometime a patient may have to be admitted and need surgery or need an MRI - you're able to schedule that sooner and take care of the patient because you already know if the patient needs a precert.

This has also been a HUGE help with collections.  We have an idea of what the patient may owe for deductible/coinsurance and if we need to do precert on anything.  This has made our denials/claim rejections go WAY down.  Our patient collections are up also because we are able to collect a better portion up front.  We are turning fewer patients to collections due to non payment of balances.  If you keep a track of how many claims are being unpaid/written off due to incorrect information, no precert/authorization done, etc - the manager and providers may change their mind quickly if they see how it affects the bottom line.

 

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