Is insurance valid? Process is high-tech
Is insurance valid? Process is high-tech
Not long ago, a registrar would assume a patient was providing accurate information, only to find out the claim was denied due to incorrect insurance, reports Michelle M. Mohrbach, CHAM, manager of patient access and central scheduling at Blanchard Valley Health System in Findlay, OH.
"Sometimes patients would present with two or three card choices, because they were hesitant to throw any away," she says."With the software that's available now, you can know in a matter of seconds if the patient has active coverage."
At one time, says Mohrbach, registrars had to be familiar only with Blue Cross/Blue Shield, traditional Medicare, traditional Medicaid, workers' compensation, and automobile insurance.
Today's registrars deal with preferred provider organizations (PPOs), health maintenance organizations (HMOs), managed care organizations (MCOs), and third-party administrators. "It's not unusual to have between four and six Medicare and Medicaid HMOs, along with the traditional option," says Mohrbach. "Patients can also elect to change every 30 days, making it more of a challenge for the registrar to stay on top of things."
Registrars sometimes pre-register a patient at the end of the month for a date of service the beginning of the following month, and find that the insurance already has changed. "We are constantly verifying benefits, both checking in real time and in nightly batches," says Mohrbach.
Online web access to payer sites means that registrars no longer need to spend hours on hold waiting to verify benefits. "Using online web access, they're able to find co-pay and deductible information in minutes, no matter what shift the specialist is working," she says.
Mohrbach's staff use verification software to identify active coverage, co-pays, deductibles, and out-of-pocket expenses, so they can tell patients what is covered and what they will be responsible for.
"Patients scheduled for high-dollar testing especially appreciate this information being provided to them prior to their visit," she adds. Registrars are able to offer payment options, prompt pay discounts, and screenings for the state's Hospital Care Assurance Program and charity program eligibility.
"By doing more screening and collections on the front end, we're helping to expedite the billing cycle," says Mohrbach. "We've found patients are more willing to talk before the service is received."
Source
For more information on insurance verification processes, contact:
- Michelle M. Mohrbach, CHAM, Manager Patient Access/Central Scheduling, Blanchard Valley Health System, Findlay, OH. Telephone: (419) 429-7655. Fax: (419) 424-1864. Email: [email protected].
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