Jobs change; marriages happen; children are born; open enrollment starts. Throughout the year, a patient’s health insurance coverage can change via these four options or many more. Although most organizations focus on updating insurance information each January, it’s important to do it year round. Capturing accurate insurance information ensures smooth clinical operations and medical billing. Use these five resources to prioritize catching health insurance changes as they happen.
Front line staff: Staff the front desk with smart, well-trained healthcare administrative employees. Since they frequently talk with patients, these staff members play a vital role in capturing a patient’s insurance. Instruct these staff to ask the patient to confirm their insurance when scheduling appointments and at check-in. Train these staff members on how to properly update a patient’s insurance, either in the patient’s file or in the electronic medical record. Also teach these staff members how to use resources to
The patient: Most patients come to the doctor’s office prepared. They should be able to tell you which insurance they have, and what their identification numbers are. If they are unable to provide proof of active insurance (i.e. a health insurance card), front line staff should be aware of the preferred course of action. For example, some organizations will allow the patient to check in with the promise that the patient will update it later. Other organizations will instruct staff not to check in the patient without proof of insurance.
The patient’s insurance card: Although they like to change things all of the time, there is one thing that healthcare organizations can count on. And that is the fact that a patient’s health insurance card will be a treasure trove of information. Typically, this is where you can find information about a patient’s member and group identification numbers as well as the billing address to send the bills to the insurance company for processing.
An updated list of health insurance changes: Create a list (or another tool) that captures the insurances that an organization is contracted with and the ones that the organization is not contracted with. This tool should be available to all staff members who update or work with a patient’s insurance. Since changes frequently happen, regular updates to this tool are required.
Access to an eligibility portal: Investigate if there are online eligibility portals that staff can use to confirm eligibility or referral authorization. These are time saving tools, because it minimizes the number of times that staff have to call a patient’s insurance.
Regardless of size, it is important for all organizations to quickly capture any insurance changes for a patient. After reading the list, take a moment to consider what is working well and what could be better. Adjust as needed.