A claim can be denied even before a patient is seen by the physician. Essentially, the revenue cycle begins when a patient calls in to schedule an appointment. As simple as it may sound, the primary cause of most pre-visit denials is the lack of a checklist. What we don’t find in centers after centers, is the execution of the following list before every patient visit:
1. Is the patient eligible?
2. Has the insurance authorized for this procedure?
3. How much co-pay is due for this visit?
4. How much in deductibles will this patient have to pay?
5. Is there a past balance?
Checking off each activity off the list can significantly help reduce denials. Common excuses for practices to detour the process are “We do not have to do it for all the patients” or “We have a huge patient volume, this is impossible”. Due to the lack of this pre-visit process, surgery centers and practices have suffered in terms of growing denials and backlog in patient receivables.
The process can look more or less like this – say, a patient calls in for an appointment; the front desk can schedule the appointment considering physician’s schedule and vacant slots. Get eligibility for scheduled the patient done at least 2 days in advance and authorizations at least 5 days prior to the date of service. Hence, less confusion at the time of service. This can be done online or by single phone call to the carriers. Front desk can inform the patient about past liabilities at the time of appointment scheduling and collect the balance upfront. This helps to contain patient receivables.
Implementation is vital as it makes way for a more efficient practice. It is less hassle for the practice to chase down denials and receivables and for patients who have to pay up for non-covered or non- authorized procedures.