The importance of patient registration in capturing accurate information, including the referring physician data and verifying all information provided by the patient is very important. Demographic, financial, and referring physician information must be gathered. If a patient schedules an appointment at least 3-4 days in advance, mail the copy of the practice brochure (serves as showing care to patient's health), financial policy, map and patient registration form for patient to complete at home.
Insurance coverage or eligibility for public medical programs changes from one month to the next for thousands of Americans. Offices should keep in mind that providers of "good faith credit" for medical services rendered to patients. Often, patients are extended credit without adequate review of their creditworthiness or discussion of their full financial responsibility.
Insurance Verification Process
The business staff of the medical office are responsible for the verification of all patient demographics and insurance plan coverage for the services provided to patient's care plan, prior to rendering services to patients. The process is explained below:
1. Before patient is accepted as a new patient, and before rendering care the office staff will obtain:
1.1 The patient demographic form must be filled out completely by
(a) interviewing the patient over the phone
(b) patient fill out the form via mail or
(c) patient complete it the office, upon arrival
1.2 Copies of hospital admission (if any)
1.3 Copies of all insurance card (front and back)
1.4 Copy of guarantor's driver's license (front only), if required by your state
1.5 Coordination of Benefits (COB) e.g. primary, secondary or tertiary for multiple policies
It is extremely important to assign the proper order of multiple plan to prevent sending
claims and get paid multiple times from insurance companies.
2. The billing staff will verify the insurance policy coverage information electronically or manually by telephone contact and cross-reference information from resources:
2.1 Patient and guarantor addresses are to be cross-referenced by telephone directories, postal addresses, driver's licenses,employment confirmation or other sources for current info
The patient demographic information and guarantor can be cross-references and
verified by multiple skip tracing online resources:
Anywho Skip tracing resources or Anywho Reverse Directory.
Bigfoot Site includes a people search option.
InfoSpace Skip tracing resources.
InfoUSA Skip tracing resources.
Search Bug Skip tracing resources.
Switchboard.com Skip tracing resources.
WhoWhere? Skip tracing resources from Lycos.
Yahoo People Search Skip tracing resources.
Currently there are number of bills pending in Congress aimed at restricting the flow of personal data in cyberspace. Perhaps in the future this information will o be so easy to obtain; however conducting a successful electronic search is relatively easy at present.
2.2 Each insurance plan provided by patient is to be contacted to verify insurance coverageCurrently there are number of bills pending in Congress aimed at restricting the flow of personal data in cyberspace. Perhaps in the future this information will o be so easy to obtain; however conducting a successful electronic search is relatively easy at present.
by using verification form of the practice.
3. Enter only the confirmed and verified information to the verification form. Changes to patient source document are to be marked with red pen, dated and initialed.
4. After all policy coverage(s) have been verified, the
completed verification form must be copied. The original is placed in patient's chart. The copy must be stored in a three-ring binder labeled "Insurance Verification Forms Profiles".
Additional Info:
Can be stored alphabetically by insurance and then patient must be alphabetically arranged per insurance storage in this three-ring binder folder.
Basic Benefits Data
The insurance benefit question are to be ask written as follows:
1. Preexisting Wait Period:
Some policies do not provide benefits for certain conditions for predetermined period of time. Example: 12-18 month waiting period for a particular service or procedure (no benefits until plan is over 12-18 months into effect). Some carrier policies plan do not provide benefits for certain conditions, diagnoses, or preexisting conditions regardless of period of time. If this is the case, write "non-covered".
2. Annual Deductible Amount:
What is the insurance annual deductible amount? This is the amount patient must pay before insurance will start to cover services.
3. Deductible Paid to Date:
How much has the patient paid toward the deductible as of today?
4. Out-of-pocket expenses:
This is the cost-sharing program that includes co-payment and coinsurance provision:
Coinsurance- Percentage of patient financial responsibility
Co-payment (Type of Service)- payment at time of service usually $10-$25 per visit (see
insurance card)
5. Second Opinion Requirements:
Does the plan have second opinion requirements for specific conditions before payment of service benefits?
6. Verified with (name):
The name of person from the insurance plan to whom the verification clerk has been speaking to identify policy coverage.
7. Phone number of verification representative:
The phone number of the person from the insurance plan to whom the verification clerk has been speaking to identify policy coverage.
8. Date verified:
Date information was verified.
Procedures and Services Data
This is designed to capture individual policy coverage information for all services that may be rendered by the physician. Services to be verified for coverage will vary from specialty to specialty, so think about the services needed frequently for a specific practice.
When asking each insurance representative:
Ask the questions below for each service:
Covered? Coverage Details/Limits
Office Services Y / N _____________________________
Hospitalization Y / N _____________________________
Consultations Y / N _____________________________
ER Visits Y / N _____________________________
Laboratory (Chem) Y / N _____________________________
Procedures Y / N _____________________________
Injections / Tx Y / N _____________________________
Supplies Y / N _____________________________
Drugs / Meds Y / N _____________________________
Exclusions? Y / N _____________________________
Ask about CPT code to identify variations of coding requirements.
Do you use current CPT code book?
When must the new CPT codes be used (e.g. effective date)?
How does your plan define "global surgical package"?
How does your plan define "global surgical periods"?
Are complications from surgery bundled in postoperative care? or
Can treatment be reported separately with appropriate modifiers?
Ask about any any service limitations, coverage and service exclusions
Are there any reduction is payment if performed in an outpatient hospital setting?
How are multiple surgical procedures reimbursed?
1st procedure ___________
2nd procedure ___________
3rd procedure ___________
4th procedure ___________
5th procedure ___________
What are their payment supplies policies?
Are HCPCS codes required or is 99070 acceptable?
How are injectable drugs reimbursed and how should they be reported (J codes)?
