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How to Survive the Inevitable Q1 "Blizzard"
Don't get snowed under.
By Virginia Pickles, Contributing Editor |
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Whether your practice is in Maine or Southern California, you need to prepare for a blizzard come January. Of course, we're talking about the blizzard of paperwork — actual and virtual — that hits when deductibles reboot and many patients change insurance plans. You can't avoid the storm, but you can minimize its impact by taking some proactive steps.
Make Pre-appointment Calls Count
During the first few months of the year, staff members at the Vision Companies in Louisville, Ky., make their pre-appointment phone calls several days in advance of a patient's appointment. These calls serve a dual purpose, explained Executive Director Sarah Cwiak, MBA. In addition to reminding patients of appointments, staff members ask insurance coverage has changed. They also discuss the plan's deductible, which is likely to be due in its entirety at the patient's first visit, and how the patient plans to pay it.
"Many patients are opting for high deductibles," Ms. Cwiak says. "So even if someone has the same insurance, he may be faced with a $2,000 deductible at the beginning of the year. This needs to be discussed."
These phone calls are typically more time consuming than at other times of the year, Ms. Cwiak noted, but gathering this information and discussing deductibles and payment options ahead of time can save time and surprises in the office on appointment day.
Review Insurance Cards at Every Visit
Even practices that verify insurance coverage before a patient's arrival are asking for insurance cards at each visit. Why? According to Don Shay, practice administrator at Retinal Consultants of Houston, patients sometimes don't update their information in a timely manner, and sometimes they don't even realize their insurance has changed.
"This often happens when patients switch from Medicare to Medicare Advantage," he says. "When they call for an appointment and we ask if they still have Medicare, they may say yes because they think Medicare Advantage is the same as Medicare. Unfortunately, if we don't learn about this change until the patient shows his card in the office, we must do a benefits investigation on the spot. The patient has to wait longer to be seen, or he may need to reschedule the visit because he needs a referral or prior authorization." By asking for insurance cards at every visit, you may be able to identify these issues prior to the first-quarter blizzard.
Ms. Cwiak agrees. "Patients change insurance plans," she says. "Every new year, as long I've worked here, that's been an issue. Even if a patient doesn't think he's changed plans, we still ask for his card at check in, because patients don't always know."
Stay Current with Access Programs
Another issue related to switching insurance plans and opting for high deductibles is access to care. Patients may change insurance without checking the benefits thoroughly and then find they don't have the coverage they need for their treatments. Retinal Consultants of Houston has one staff member dedicated to matching patients who need financial assistance with the appropriate access programs. Some corporate programs, such as Genentech Access Solutions, can help patients whose health care plans don't pay for their medicines or have concerns about their co-pays, co-insurance and other expenses. "Patients who have only Medicare sometimes can't afford the 20% they owe," Mr. Shay says. "So we want to enroll them in some sort of program to ensure that they get the care they need and we get paid."
For any of the access programs, patients must prove eligibility. "That's where our staff member lends assistance," Mr. Shay says. "That's all she does. Because of our case volume, we can't afford not to have someone on staff responsible for patient access."
Weather the Storm
Both Mr. Shay and Ms. Cwiak agree, there's no avoiding the Q1 blizzard, but being prepared and temporarily redirecting your resources, may help you weather the storm.
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