Ugh. Verifying patient benefits is a necessary step, and one that seems like it should be simple – but often involves phone tag, double-checking with insurance companies, and triple-checking with patients. And it creates all kinds of exposure: even small errors like a mislabeled address can significantly impact provider payments.
In a time when it takes an average of 30 days to collect a medical bill of $1,000 or more, most practices can’t afford this type of mistake.
When your verification processes are in place, you lead patients to a place of greater trust and satisfaction with your services. So let’s break it down. Three easy steps that your outpatient rehab therapy practice can use to boost reimbursement and create a seamless experience for your patients.
Step 1: Get the Facts, ASAP
Get insurance information from new and returning patients as soon as possible, so you’ll have more time to double-check every detail. Online digital intake makes it simple for patients to use outpatient therapy software to fill out and submit forms before they arrive.
At a minimum, patient forms should collect:
- Patient name
- Patient date of birth
- Insurance company name
- Name of the primary insurance holder
- Relationship of the insurance holder and patient
- Policy and group ID number
- Address and phone number of the insurance company
Be sure patients know they have to provide this information for each and every insurance plan if they have more than one form of coverage. For best results, plan to verify patient insurance coverage every month, even for those who visit the practice more frequently.
Step 2: Find the Fastest Way to Verify
There are three ways to verify patient info before their next appointment:
- Call the insurance company
- Try to call when lines aren’t overloaded, such as later in the afternoon or during lunch hour
- Give yourself at least 3 full business days for phone verification, to iron out unexpected wrinkles in the process
- Prepare yourself to wait on hold for at least 20 minutes
- When an agent answers, make sure that agent represents Provider Services
- Confirm practice details, for HIPAA purposes
- Have the patient’s name, address, and birthdate handy.
- Verify online
Don’t feel like sitting on hold, on the phone? Some insurance companies have online eligibility verification services via a request form or a searchable database of patient information. But be aware: these directories might not have updated details that you would receive from a direct call with an insurance agent, so be aware that the information you find might be outdated, and so result in delayed or denied reimbursement.
- Let your EMR do the work
You can access information on patient benefits from Waystar, through Insight EMR’s EVOB (electronic verification of benefits) tool. Your request is sent to a clearinghouse for processing, and if the system is able to verify what you need, detailed coverage information will be imported directly into the EMR record. If any information is missing or incorrect, you’ll get an alert letting you know that manual verification is needed.
Step 3: Update the Patient Record
You already know that you can avoid errors by double and triple-checking patient details while entering verification information into your physical therapy EMR. As you do so, make sure you’re not missing any of the following data points:
- The policy’s active dates
- The number of remaining therapy visits the policy will cover
- The amount of the policy’s copayment or coinsurance requirements, including deductible
- Whether the policy requires a certificate of medical necessity, preauthorization, or physician referral to provide reimbursement
- Whether the provider is in-network or out-of-network according to the patient’s policy
- Other documentation requirements or coverage limits.
Based on these details, you should be able to provide the patient with an accurate cost estimate for the upcoming appointment. These steps can also help your practice increase the efficiency and success rate of reimbursements.
Why EMR Verification Might Be Right for Your Practice
By using your outpatient therapy software for EMR verification in step two above, you gain two benefits: 1) it improves patient experience, by making them do less work since office staff has their coverage information at their fingertips, and 2) increases your practice’s collection and reimbursement rates. EMR-based EVOB accomplishes both.
It also aligns with patient preferences for billing and communication. According to the Healthcare Financial Management Association, more than 50% of surveyed patients expect to be able to communicate directly with their health care providers and receive important documents such as insurance paperwork online.
Insight EMR makes it easy to get the insurance information you need for efficient claims processing and reimbursement. With this three-step EVOB process, your practice can streamline benefits verification for rehab therapy. To learn more about how the Insight Physical Therapy EMR can support your organization’s workflows, schedule a live, no-obligation demo today.
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