The task of verifying patient eligibility is a perfect example. If done improperly – or not done at all – claims can later get denied and the practice is forced to forego the revenue generated by that encounter.
Although vital to any physician practice, back-office functions are often tedious, time consuming and costly. To reduce the burden of these tasks, practices can choose to outsource specific RCM components to help streamline operations. Two specific functions that are ideal for outsourcing include patient eligibility verification and payment posting to help with the following:
1) Applying correct payment to patient responsibility as deductibles have become a big issue.
2) Applying correct payment to secondary responsibilities.
3) Creating a follow up work queue for denied or partial paid claims when compared with Insurance Fee schedule.
Eligibility checking is the single most effective way to prevent insurance claim denials. Outsourcing this service is simple. The service provider retrieves a list of scheduled patient appointments and verifies coverage using one of three methods:
- Online, using insurance company websites and payer portals
- Calling the interactive voice response (IVR) systems at insurance companies and working through menus to determine eligibility status
- Calling insurance company representatives directly when online or IVR options are not available, or to resolve more complicated situations
Outsourcing payment posting and reconciling is also a simple process, and enables providers to determine if full reimbursement was received. Outsourced service providers accomplish this via two ways:
- Manual posting – Paper explanation of benefit (EOB) statements received by physicians are collected and sent to the billing service by one of two methods. They can scan documents and send them to the service electronically, or they can simply send the paper documents to the service. Payment posting is performed in batches to ensure proper accounting and to reconcile bank deposits with EOB statements
- Auto posting – When EOB payments come in the form of electronic remittance advice (ERA), these files can be downloaded directly into the physician’s practice management system. All posting is done directly in the system, so providers can audit at any time.
Outsourcing selected components of the RCM process is an easy way for practices to streamline operations, decrease denials and ensure payment accuracy. More importantly, it’s a great way to get tasks completed correctly the first time, rather than having to endure the headaches of correcting them later in the RCM process.