1. Check insurance year round.
Coverage changes can happen anytime, so you need to stay current. For Zora A. Harrison, COE, Operations Manager at Ocala Eye in Ocala, Florida, that means getting insurance updates at 90,000 annual patient visits in four locations.

“Our policy is to get cards at every patient check-in except post-operative visits,” she says. “By doing this all year, we’re able to catch changes before we submit claims.”

2. Verify patients electronically.
In addition to verifying cards, Oregon Eye Consultants checks eligibility electronically for all 36,000 annual patient visits through their EHR. Employees submit a daily schedule in a batch, just like claims, and the resulting list shows them current insurance coverage. According to Administrator Joy Woodke, COE, OCS, “It’s an easy, efficient way to check eligibility and prevent claim denials.”

3. Scan cards (even if there’s “no change”).
When you ask, “Has your insurance changed?” and a patient answers “No,” do you still scan his card?

“It’s more efficient to scan cards regardless of whether the patient perceives a change,” Ms. Woodke tells her staff. “A patient might still have Smith Insurance, but the employer has switched from Group A to Group B, or the patient ID might change. If we only scanned cards based on the patient’s answer, claims could be denied.”

4. Maximize your recall efforts.
Ocala Eye’s recall emails, which remind patients that it’s time to make an appointment or reminds them of a scheduled appointment, asks patients to call with any insurance changes. “For patients’ convenience as well as our own, we need to make sure that we take their new insurance before they come in for an appointment,” Mrs. Harrison explains.

Her colleague, Billing Manager Dana Milton, sees the repetition paying off. “Between the recall reminders and the trained front-desk staff who verify insurance at every visit, our patients know to come in with their cards ready.”

5. Re-verify before retina treatments.
Because retina procedures can have high costs and varying coverage, Mrs. Milton and her colleagues book treatments very carefully, she says. “Our clinic manager monitors the schedule to make sure that each patient’s insurance has been verified before we schedule treatment.”

The staff at Oregon Eye Consultants is equally thorough. They maintain a grid of insurers and procedures that tell them which insurer/procedure combinations require prior authorization. “We contact insurance companies for prior authorization of retina treatments, particularly high-cost injectables, at a time close to every appointment date to ensure that coverage hasn’t changed,” Ms. Woodke says.

6. Keep staff informed.
The job of efficiently carrying out re-verification rests on your staff. It pays to keep them informed.

“I go to meetings, get pearls from other practices and stay on top of the plans marketed in our area. I pass all of that along to the rest of the staff by educating them directly or developing tools like our ‘insurance roadmap’ of plans we accept,” Mrs. Milton says.

It doesn’t hurt to emphasize that education as the New Year approaches, according to Ms. Woodke. “At a staff meeting in December, we remind staff that there will be an up-tick in the number of insurance changes after January 1, so they’ll be prepared to see more changes. And if they follow the same procedures, everything goes smoothly.”