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Stop Relying on the Patient for Accurate and Timely Payer Information 

(3 min read) When it comes to billing and revenue cycle management (RCM) services, as an industry, we have been doing the same things for the last thirty years and expecting the same — if not better — results. Patient responsibility has grown by more than 29%, and yet many of us are still using the same processes and billing systems, while lamenting our shrinking revenue.   

We blame the payers, and while I certainly am not able to absolve them of responsibility, as RCM professionals, we are also part of the problem. 

A UnitedHealthcare Consumer Sentiment Survey showed that only 9% of Americans surveyed “showed an understanding” of four basic health insurance terms — health plan premium, health plan deductible, out-of-pocket maximum, and co-insurance. The reality is that patients do not understand and often fail to provide the correct information. Patient demographic information tends to include errors or omissions nearly 55% of the time.  

That means expecting a statement that accurately captures insurance coverage and patient financial responsibility. Unfortunately, patients do not have the knowledge to understand how missing or incorrect information impacts the entire claim process and may result in an increase in their patient responsibility.  

Info from Patient is not the Gospel Truth

Information Provided by the Patient Is Not the “Gospel Truth” 

A study published in JAMA Network Openi revealed that up to 81% of patients lie to their doctors about how often they exercise, how much they eat, and other behaviors to avoid being judged. 

Let us think about that for a moment: patients don’t just lie when they feel their lack of healthy habits will be judged. They also lie when they don’t understand. We know that patients struggle to understand their own health insurance.   

Retooling the Patient Demographic Verification Process Will Increase Patient Satisfaction  

More than ever before, patients are becoming informed healthcare consumers, especially when their financial stake continues to grow. As patients engage in managing their cost of care, they need a clear understanding of what they owe for services. Billers need to discover all active billable coverage for this to occur 

I suggest providers simplify their intake process to focus on verifying the patients identity and obtaining basic information. Review the patient’s identification and ask them to verify that you have their full and correct name, date of birth, address, social security number, and where appropriate, their MBI number. Utilize a demographic verification and insurance discovery process prior to presenting the information to your billing team.  

Leverage Advanced Technology to Verify Patient Demographic Information and Discover Billable Coverage.  

Providers can deliver on patient expectations by leveraging advanced technology such as demographic verification and insurance discovery to boost billing performance. Prior to discharge or checkout, providers should process the demographic verification and insurance discovery. Review what has been found together with the patient, and leverage that information for a more productive financial discussion at the time of the encounter.   

Providers who deploy best-in-class technology can expect to recoup 29% more billable coverage on average, increase clean claim rates, and have an easier time engaging the patient in the process. To learn more about collecting accurate, billable information from patients, read the full article here. 

Read More on How to Avoid Billing Errors 

5 Simple Steps That Help You Avoid Costly Billing Mistakes, Improve Your Bottom Line, and Reduce Patient Anxiety


i”Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians,” JAMA Network Open website

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