Wild swings in the demand for care. A rapidly developing telehealth landscape. Far-reaching economic effects, meaning extreme changes to insurance coverage and uncompensated care.
Physicians across the country are having to master a brand-new set of rules and system changes to the reimbursement process as a result of COVID-19 – with only more challenges on the horizon.
Periods of intense change, especially with so much of your livelihood at stake, can cause isolation and fear amid your practice. Everyone’s feeling the pressures from all angles.
The reality is practice leaders and administrators must be forward-thinking: Now’s your time to act. Taking steps to protect and optimize your revenue have never been more critical.
So much of your revenue’s success starts with eligibility. In fact, the leading cause for claim rejections and denials are due to eligibility errors. The frustration of eligibility-related rejections and denials for small and independent physician practices is likely at an all-time high – especially in a year that has so far been devoted to managing a global pandemic and avalanche of changes related to telehealth, government health plan reimbursement and upended staffing resources.
Here’s the good news: Registration, eligibility and pre-service challenges are, in fact, some of your best chances to improve revenue.
That’s because when you stop the leaks – or implement proactive measures to avoid them – you see an immediate benefit to your bottom line.
How can you put eligibility-related claim issues to a stop? It doesn’t take a huge budget or complex technology – just a more automated, consistent approach to eligibility.
First, your staff must have its act together before the patient steps foot into your practice. More patients than ever before are responsible for a larger portion of their medical bills. It’s imperative your practice can easily determine insurance benefit details in advance of a patient’s visit:
- What services are covered?
- How much will you need to collect from the patient?
- Does the patient need to sign an Advance Beneficiary Notice (ABN) during their visit?
The result of having structured, streamlined front-office eligibility processes is reduced days in A/R, better cash flow and minimized exposure to delayed compensation on non-payment.
Available within your MicroMD platform, EDIinsight® Eligibility delivers an easy-to-read, well-organized eligibility response. Its actionable response layout always places benefit information in the same place categorically, which frees up time spent searching for the details you need. Comprehensive response reports make it easy to identify subscriber coverage information, co-pay/deductible data, ABN requirements, and more. The best part is you never leave MicroMD for this detailed information – it’s all integrated seamlessly into the platform you know.
Here are some quick tips and tricks to optimizing EDIinsight® Eligibility in MicroMD:
- Set up Eligibility Auto-Verification 24-48 hours in advance of your patients’ appointments. Be sure to create a rule in EDIinsight® to add any eligibility issues to a task list that you can work ahead of appointments.
- If you can’t reach a patient with an eligibility issue, use the HIPAA pop up window in MicroMD and enter a note to alert the front desk of the issue and remind them collect new insurance information.
- Consider altering your workflow and collect insurance information when making a new patient appointment so that auto-eligibility can run ahead of the appointment. Some practices run eligibility on demand when making the new patient appointment in order to set the expectations with the patient for the co-pay/deductible.
- Ask your MicroMD Account Manager about new solutions that allow patients to complete pre-registration from their smart phone prior to the appointment, which allows the collection of insurance information, including images of insurance cards. Entering this information ahead of time will allow the auto-verification to run and any changes like a new insurance plan can be updated in MIcroMD prior to the appointment date. If any questions arise, the provider can handle them prior to the patient visit.
- If you are using EDIinsight®, have you adjusted your service types in MicroMD to be specific to your practice? Go to Set up, Practice Preferences, Additional Modules and use the Set up icon to adjust which services you want included for your practice to help fine tune the Eligibility flags.
The payoff of a solid eligibility process is positive cash flow, fewer eligibility-related denials and rejections and a more efficient staff. Using an integrated vendor like EDIinsight® for eligibility improves workflow automation and reduces labor costs and days in A/R.
