If you’ve ever played the board game “Operation,” you know the stress involved as you remove the patient’s “organs” (one by one) from small holes in a hollowed-out box. But, there’s a catch; if you don’t remove said organs with steady hands, your surgical instrument (tweezers) bumps the sides of the “patient,” resulting in an electric zap—hence the stress. Although benefits verification doesn’t produce an electric shock if done incorrectly, the outcome can be similarly unsettling if you get it wrong. And, like with Operation, benefits verification requires focus and a series of carefully followed steps for success.
In an effort to help you steady and ready yourself for a less painful benefits verification process, let’s look at four steps to reduce shocking and stressful verification results.
Don’t get zapped by benefits verification mishaps: Know what you’re up against.
Any successful operation begins with a full understanding of the patient’s history and health. As PTs, you know this more than anyone. You wouldn’t go straight to treatment prior to conducting an evaluation. The same goes for benefits verification. To make the process smooth sailing, it’s best to first understand the challenges you face ahead. This includes (but is not limited to):
- Interruption: Whether you run a busy front office or a smaller-scale practice, the likelihood of mid-task interruption is high.
- Clerical errors: It happens to the best of us. But, even (seemingly) innocuous typos like one wrong digit in a birthdate or a missing letter in someone’s last name can lead to Claim-Denial City (because when there’s one denial, there’s usually five more on the way).
- Time shortage: Contacting payers is a necessary evil when verifying patient benefits—but the most sinister part is that there are so many payers with so many different processes and requirements. While this isn’t so bad if you’re verifying one patient, it’s taxing with multiple.
Okay, now that you know possible trip-ups, let’s put a strategy in play.
Begin operation “stress less benefits verification.”
While we can’t guarantee a complete stress-free benefits verification process, we can provide a few steps to (hopefully) make things a little easier so you stress less.
Step One: Collect the necessary patient deets.
Before you pick up the phone to call a payer—or click your mouse—to verify benefits, have the following info on hand to help the process go more smoothly:
- The patient’s name and date of birth
- The name, address, and phone number of the insurance company
- The policy number and group ID (if needed) of the patient’s insurance
- The name and relationship of the primary insurance policyholder to the patient
- Any and all details for slated procedures or services (e.g., ICD-10 or CPT codes)
And, as Melissa Hughes discusses in this blog post, it’s always good to have a patient’s secondary insurance—if applicable—at the ready as well. (You’ll need the bulleted information listed above for that, too!) Many benefits verifiers have also found it helpful to run through the following payer-question checklist:
- What is the patient’s policy end date?
- How many remaining therapy visits does the patient have for the rest of the year?
- Does the patient have a copay, and if so, what is it?
- Does the patient have a deductible, and if so, what is it?
- Do you need a referral, pre-authorization, or medical necessity for reimbursement?
- Is the therapist the patient plans to see in- or out-of-network?
- Does the coverage have any limitations or document requirements that must be fulfilled prior to the patient’s visit?
These questions will become second nature, eventually. But, regardless of whether you’ve been doing eligibility checks for a week or well over a decade, it’s always good to make sure all the bases have been covered.
Step Two: Reach out to payers.
Not all payers allow electronic benefits authorization (boo!). However, a great many do. Insurance companies often have online portals designed specifically for providers to securely locate and check eligibility and benefits. Once you’ve arrived on a provider site, there’s typically an area inviting you to “search for members.” Here are a few examples:
Once you’ve found your patient, use the criteria listed in step one to check their eligibility.
Now, what if you’ve searched the web from here to Timbuktu and your provider doesn’t offer electronic benefits verification? As is the case sometimes, you’ll need to pick up the phone. But before you do so, here are a few things to keep in mind to make the process flow more smoothly:
- Have the patient’s information (i.e., the lists from step one) in front of you.
- Once you’ve reached a live person, confirm that the payer representative you’re speaking with is the appropriate person for the task at hand (sometimes you may need to be transferred to another department).
- If you’re unable to reach someone who can properly assist you, call the payer back at a different time during the day or later in the week. Try to avoid times like early mornings and lunch hours.
Remember too, that hold times—as frustrating as they are—come with the territory of benefits verification. However, calling during non-peak times (which you’ll discover over time) will help reduce the length of those hold times.
Step Three: Leverage a software solution that streamlines the eBV process.
Utilizing an electronic benefits verification (eBV) program can significantly loosen bottlenecks like those we initially outlined—interruption, clerical error, and time shortage. These technology solutions can automatically verify benefits for you—saving time, reducing inefficiencies, and streamlining front-office operations by bringing multiple tasks into one platform. So, rather than going back and forth, copying and pasting benefits information, use an eBV technology integrated with your EMR to eliminate this step and reduce errors. Just make sure that when you’re shopping for a software platform, it has these basic features:
- A robust database of insurance companies;
- Built-in interoperability with your existing EMR;
- Automated benefit verification and patient registration;
- Double-data entry fail-safes and other clerical-error detection; and
- Quick sorting, review, and management of all benefit verifications within your EMR.
While interruptions may occur in a front-office environment, an integrated eBV software keeps track of where you’ve left off. Additionally, the risk of typos is significantly reduced. And, even though you may need to call a portion of payers (those not included in an eBV database), easy access to many others will help you get ahead on your verification workload. Ultimately, however, your greatest benefit of leveraging EBV technology for benefits verification is fewer denied claims!
Step Four: Get ahead as much as you can.
Almost every “how to” guide on benefits verification promotes conducting this process monthly. This way, you don’t have to scramble every time a patient comes in with a policy change. And, while this is excellent advice to be sure, it’s not always feasible. There simply has to be another “how to” hack that makes the whole operation of staying ahead easier. Waa-laa—there is!
Shortly prior to—or just after—the new year, consider using your EMR marketing and relationship management software to send a mass email to patients, asking them to submit any insurance changes—and give them a due date—as in the example below.
Many people experience benefit/insurance changes at the beginning of a new year. We are reaching out to inquire if your insurance will be changing as of January 1, 2022.
If any of your insurance information is changing, please confirm all changes in a timely fashion to reduce billing issues. Below you will find a link to verify your insurance information for the upcoming year. We will need your response before the end of 2021.
We thank you for the opportunity to serve you and hope to see you soon.
Your Favorite PT
Not everyone will return the information, but for every person that does, you get twenty more minutes you can allocate to other important tasks.
Don’t forget about operation “conduct bi-annual assessments for eligibility check success.”
Anything you can do to be proactive will help keep you away from claim-denial danger zones. Even if you don’t have time for monthly patient-insurance audits, a bi-annual assessment can set you up for operation eligibility check success.
What benefits verification strategies have you found that make the process a less invasive operation? Share them with your colleagues below.