“In order for any business to succeed, it must first become a system so that the business functions exactly the same way every time down to the last detail” – Rick Harshaw, Monopolize Your Marketplace
In my last article, we talked about the importance of credentialing and payment reconciliation. These are important systems for the insurance-based practice. In this article, we will talk about the importance of following-up on claims and verifying benefits. Fair warning, this is the hard part of a DIY practice or a practice that is taking insurance.
1.Following Up On Claims
The number one principle of success for claim follow up is document EVERYTHING! Claim follow-up is complicated and can involve steps like:
- Calling an insurance company
- Being transferred 3 times
- Calls being dropped
- Reference numbers
In all of the chaos, it will be important to have a central document that shows what you have done with claims, who you spoke to, and how long it has been since something has been done.
We recommend setting up an excel sheet that tracks every claim and every activity, but there are other ways of monitoring actions. You can always:
- Document follow up activities in your EHR
- Use a HIPAA compliant project management software
- Use an excel sheet
- Use a Google document
Whatever system you use, make sure you can understand it and know where outstanding activities left off.
2. Verifying Eligibility and Benefits
One of the most overlooked parts of the billing process and system is verifying eligibility and benefits. The reason why most practices don’t is that verifying eligibility and benefits is labor intensive and frustrating. The reason why checking eligibility can be frustrating is because they are only accurate 70% of the time industry-wide. That means that 1 out of every 3 eligibility checks will be incorrect or yield incorrect data.
However, there are ways to avoid inaccuracy. Here are some tips for getting the correct information:
- Use an online portal like Availity
- Use a payer specific portal
- Use a script when you call insurance companies
- Put together a repeatable form for eligibility and benefits
You will want to automate the process as much as possible. One of the best ways to ensure that this process doesn’t take up too much time is to delegate this process to someone who can do it for you, like a VA or an administrator.
Using these tips to create your billing processes and systems will help guide you to remuneration for your services. We say that each session is a financial transaction and should lead to payment. Set up automated systems and structures that take the mental strain off of the process and speed up payment.
Jeremy grew up in the Pacific Northwest where he discovered his passion for people. He decided to go to college in Chicago to further develop his skills working with people and pursue a degree in counseling. While in Chicago he worked for a group practice as a practice biller and marketing manager. This initiated his desire to pursue learning about the business of Private Practice, particularly medical billing. Jeremy’s website: https://www.practicesol.com/
He now lives in Michigan with his wife of 3 years. They both are pursuing their passion of helping helpers maintain sustainable and compliant billing practices. In his free time, Jeremy loves reading, fishing, biking, hiking, and camping.