In the world of emergency ambulance transportation, we oftentimes find it hard to verify if a patient has insurance coverage at the time of treatment. Our clinician’s top priority is patient care, often leaving responsibility for verifying insurance on the billing office.
Based on my experience, there are three things to carefully consider when creating an efficient verification process for your organization:
- Based upon demographic information, you can sort accounts into ‘buckets’ fairly quickly based upon several factors, such as: the age of the patient, zip code, accident or injury claims, and even employer information. This will help your verification teams to target certain payers such as Medicare, Medicaid and particular commercial payers based upon this demographic information.
- There are several vendors or internal procedures that you can deploy to automate the verification process without manual verification. This strategy will assist in decreasing your days to bill along with you FTE count by allowing your billing office to focus your human resources on back end processes, such as appeals and challenging improper payments. As an example, let’s say you have Medicare information, but have not verified it for accuracy. Instead of manually calling the insurance company or checking it via the website, why not just submit the claim? If the information is not accurate, the claim will reject on 1st edit. This notification is usually provided same day of submittal (or the very next day). If the information is correct, it will process through the system, and you avoided the manual verification process, thus saving your resources for those accounts that require manual intervention.
- Not all employees are created equal. Some employees are better at researching and investigating than others will be. These are the individuals you want in your verification process for the accounts that need manual intervention. Focus your resources accordingly and you will be pleasantly surprised how you can increase your revenue per patient and decrease your cost per patient.
For non-emergency ambulance transportation, I strongly encourage you to set up a verification process prior to transport to determine coverage. This is not only a benefit for your service, but for the patient you serve. A patient should never be surprised during the billing process if it is within your control to notify them prior to transportation.
Remember, Prioritize. Automate. Focus. What we are intentional about we will accomplish.