As I talked about in the last blog, the business side of health care has gone through some big changes in the last few years and will continue to change as we move forward into the future. That’s why it’s important that chiropractic clinics continue to be aware of these changes and how to perform the billing and collections processes in the most efficient and effective manner.
In the past, most patients had co-pays and they weren’t as likely to be switching health plans on a regular basis as they do now. Therefore, Eligibility & Benefits Verification wasn’t nearly as important as it is now.
With more and more patients moving from co-pay plans to deductible plans, chiropractic clinics need to build Eligibility & Benefits Verification into their billing and collections process. This will improve their time of service collections, as well as their clean claim rate.
It used to be that if a patient had a $250 deductible and the patient or the clinic didn’t know if the deductible had been met, the clinic wouldn’t have the patient pay anything at the time of service and then would submit the claim. With the small deductible the patient was much more likely to meet their deductible in a short period of time and the clinic would receive their payment without having to wait too long.
But, with today’s high deductible plans, the clinic is just “kicking the payment can down the road” when they don’t verify the patient’s eligibility and benefits to know whether or not the patient has met their deductible, which they likely have not.
In the past, when health plans weren’t nearly as complicated as they are today, I agree that it was the patient’s responsibility for knowing what their insurance benefits were. However, as the plans have become more complicated, even for those of us in health care, I believe it is now the clinic’s responsibility to verify and understand the patient’s benefits. This not only helps the clinic’s billing and collections process, it also improves the patient experience. As one group defines it, the clinic becomes more of an “advocate” for the patient rather than being a “collector.”
Verifying eligibility and benefits has become much more efficient as well. While calling on the telephone to verify a patient’s eligibility and benefits is still the required method for some payers, many payers and health plans now have web portals that providers can use to verify the patient’s eligibility and benefits, including the balance of their deductible. Electronic claims clearinghouses also have portals that make it very efficient to do the verification on-line in real time.
Looking into the future I foresee a time when the EHR will be able to look at the appointment schedule for the next day and automatically run an eligibility verification report, in the middle of the night, and have the report waiting for the front desk person when they arrive in the clinic every morning.
So, no matter how you choose to perform the Eligibility & Benefits Verification, I strongly encourage you to build this task into your daily routine. Not only will it improve your billing and collections processes, it will also improve the experience your patient’s have each time they come into your clinic.