Maximize Reimbursement: Train Intake Staff

Did you know that maximizing reimbursement begins with the very first contact with your agency either from a patient or an Insurer?  Each phone call, fax or electronic transmission must be carefully recorded and scrutinized so that key data is gathered prior to the start of care.  Only then can you make an informed decision as to whether you can or should treat this patient.

Does your staff know the key information that must be collected and reviewed prior to accepting a new patient?    In most cases, delayed or reduced reimbursement can usually be traced to an initial communication error.

  1. Copy of all medical insurance cards (front and back). Cellphone photos emailed to the agency make this so simple for most people.
  • This is the most efficient way to determine the correct spelling of first and last names that will appear on your claims.
  • The back of the card will provide the Insurance telephone numbers that will be necessary to verify pre-authorization and Provider services telephone numbers. (key information for billers if claim is denied)
  • Not all B/C & B/S, Anthem, Humana, etc. plans are created equal. It is necessary to determine the exact plan benefits. Today, many patients have opted for “High Deductible” plans that can have deductibles and OOP (out of pocket) expenses that may mean the agency will have to collect thousands of dollars from the patient before their insurance will pay anything.
  • Is your agency in their “network”? If out of network your reimbursement may be reduced.
  1. Verify the patient’s Date of Birth – this is not on the insurance card but is often a reason for Insurance companies to deny payment.
  2. Document the exact name and telephone number of the facility discharging the patient to home.
  3. PCP Name and phone number.

These may seem obvious to a skilled “intake” staff person, however they are so often neglected and can lead to months of unreimbursed claims. Once the above information is gathered and analyzed it must be input to the billing system correctly and carefully.  Very often transposed numbers or misspellings can add to claims rejections.

Help your staff understand the importance of the “Intake process” in your agency’s financial success and cash flow efficiency.