(7 min read) When providing healthcare services — whether that be in the pre-hospital (EMS) or traditional hospital setting — we are entrusted with the care of vulnerable patients. Patients are medically vulnerable, often with significant and potentially life-threatening conditions. At the same time, patients are also financially vulnerable. While it’s the patient’s responsibility to provide accurate information, they don’t always arrive with everything in hand. Healthcare services are expensive, and errors and omissions that we, as healthcare providers, make in information gathering, documentation, and billing can cost the patient significant out-of-pocket dollars that should not be their responsibility. Medical debt is one of the most common reasons that people file for bankruptcy, and we have a professional responsibility — and an ethical duty — to make sure we provide medically necessary services that are well documented and billed to the proper payer for the proper amount. The goal should be to provide our patients always with the highest level of care with their medical and financial vulnerabilities in mind.
We can reduce the patient’s financial vulnerability by following five simple steps that can help keep the patient from getting stuck with a large out-of-pocket expense. These steps can also help ensure you obtain the maximum (and proper) reimbursement available for the services you provide.
Obtain Patient Information at Time of Service
You should capture as much patient demographic and insurance information as you possibly can at the time of service and as early in the patient encounter as is reasonably possible. As the patient’s condition allows, that should be in the ambulance or at the time of transfer. This window of opportunity is when the patient needs you the most and is most willing to provide you with any information that you request. This means getting the correct spelling of the patient’s name, address, social security number, cell phone number, and insurance information whenever possible. Waiting until after the patient encounter may involve chasing after a patient who no longer needs you; thus, they are less likely to respond promptly to your requests for basic information. On occasions when a patient is not completely forthcoming, staff must be trained and ready to respectfully and assertively reiterate the urgency of obtaining their information.
Very often this only takes a few seconds, or at most, a few minutes and can be done in those moments when you are not providing direct patient care. Not capturing this basic information as soon as possible means the job of obtaining it may be relegated to others later on. In the best case, this approach causes delays in getting the information, and in the worst case, the opportunity already may have been lost. In the latter case, you may never capture payment to which you are entitled.
Follow the Patient Signature Rules
Medicare and insurance companies require that the patient sign an assignment of benefits (AOB) statement that assigns payment under the patient’s benefits plan to the healthcare organization providing the patient care. This form may also provide patient consent for care language.
Without a proper AOB signature on file, it may be impossible to submit the claim for patient services to the proper payer. The bill for your services may then need to be sent to the patient, which can create a lot of anxiety for the patient. In most cases, there are exceptions to obtaining the actual patient signature when the patient is physically or mentally incapable of signing. In those situations, a representative of the patient may sign on their behalf.
There are also special exceptions for ambulance services, in circumstances when the patient is incapable of signing and no representative is available or willing to sign, but only if documented at the time of service! Obtaining a signature on an AOB takes a matter of seconds in most cases, but it may take days and weeks if the billing office must pursue it.
Determine Who is Responsible to Pay
There are various rules as to who is responsible for payment of the claim for medical services. If the patient is covered by Medicare, Medicaid, or has health insurance, then the insurer is the proper payer. Insurance discovery technology finds all billable coverage options in real time and prevents misidentification of expired coverage and misclassification of patients as self-pay. Insurance discovery also identifies charitable options, including Medicaid.
In some cases, such as when ambulance services are provided to the patient, the hospital or skilled nursing facility may be responsible for payment as is the case when the patient is in a Part A stay. Identifying which payer should be billed and getting it right the first time can save time, reduce days in accounts receivable, and avoid the distress that comes when payment is outstanding, and the patient gets billed unnecessarily.
Know Your Patient’s Insurance Profile
Today’s revenue cycle technology provides many options for electronically searching the patient’s profile to obtain current and up to date insurance information. The key is often to obtain the patient’s correct spelling of their full name, their date of birth, and their social security number. Demographic and insurance verification tools can help ensure that these essential data points and coverage are complete and current. Again, this information can be obtained up front, in the early minutes of the patient encounter. The “sooner the better,” as they say, and at the same time. It’s imperative that you train your staff to be diligent in this area. Too often, staff members are uncomfortable asking the patient for the information, passing the responsibility downstream without understanding the headache being created both for the patient and provider.
We’ve seen many claims denied simply because of a minor transpositional error, misspelling, or other seemingly minor discrepancy in patient demographic or insurance information. In a nutshell, healthcare providers who do not pay attention to these seemingly minor, but very important details, can create distress for the patient and reduce the likelihood of your organization getting paid properly and on a timely basis.
Practice “Right Day Billing”
The patient accounting practice of the past was to get the bill out as soon as possible after services were provided to reduce the time it takes to get reimbursed – the first bills in the door of the insurer were most likely to get paid. That is no longer the case in this era of high deductible insurance plans. Healthcare providers must practice deductible monitoring to ensure that the claims submitted are properly timed so that your services are less likely to be consumed by the deductible, making it the patient’s responsibility to pay the claim out of pocket. We all know that can sometimes be as difficult as getting blood out of a stone. The good news is that deductible monitoring technology makes this process painless and very effective.
There are many good revenue cycle software programs — including ZOLL® RescueNet® Billing Pro and ZOLL Billing for ambulance services and ZOLL AR Boost® for healthcare organizations — that can quickly and accurately identify patient insurance and determine the likelihood that you will be paid. Timing the bill to go out on the “right day” after deductibles are met, can improve billing efficiency, reduce your costs, and significantly increase your revenue. As an added advantage, it will also prevent undue anxiety for the patient.
By following these five simple and commonsense approaches, your organization can reduce the patient’s anxiety about the cost of services and keep their financial vulnerability in check.