Insurance re-verification is at the front and center of practice priorities every year. It’s time for you and your staff to find out if patients have new insurance. — and even if they kept the same coverage, it’s important to note that insurers can change what and how much they cover for various procedures. To ensure that a patient’s insurance covers his upcoming retina procedure – even if it was covered in the past – you must verify it with the insurer. The biggest challenge is in verifying all of your patients in an efficient manner that doesn’t excessively drain staff time.

At Oregon Eye Consultants, the staff does just that by maintaining a quick-reference Insurance Grid.

Quick-Reference Tool
When staff members at Oregon Eye Consultants found it time-consuming to check each patient’s insurance coverage for specific procedures on an individual basis, they decided to find a better way. The result was a simple quick-reference Insurance Grid that details insurers’ requirements for such procedures as retina injections, blepharoplasty and other procedures that typically require prior authorization. (See Figure 1.)

The staff keeps an electronic version of the grid on a shared network drive and surgery coordinators keep a printed copy nearby for easy access.

“We do so much testing and treatment, and we absolutely need to know not only if a patient’s insurance has changed, but also if the insurer has changed its coverage requirements for a particular test or procedure,” explains Administrator Joy Woodke, COE, OCS. “In particular, if we find out about a change in preauthorization requirements after the fact, there are consequences as far as denials.”

Updates and Supplemental Tools
Because insurers’ preauthorization requirements can change, Ms. Woodke ensures that the Insurance Grid is updated. “I ask business office representatives and surgery coordinators to go online quarterly to check the insurance prior authorization list,” she says. “We’ve found that these can change a few times a year.”

Assured that the Insurance Grid contains current information, staff members use it to verify coverage, and then file for preauthorization quickly and efficiently thanks to some added preparation.

“On the same shared network drive where we store the Insurance Grid, we also organize additional information and prior authorization forms for each insurance company,” explains Ms. Woodke. “Staff members can access forms that are already completed with company and/or physician data, which helps us file the forms efficiently.”

Filing for preauthorization completes what’s essentially a three-part verification for patients undergoing retina procedures. Staff members verify insurance coverage for all patients, verify coverage requirements for specific procedures using the Insurance Grid, and then file the necessary prior authorization forms. The filing is performed close to the procedure date to ensure that the practice’s information on both the patient’s insured status and the insurer’s coverage requirements are up to date. The result: a smooth re-verification process at Oregon Eye Consultants and no problems with reimbursement of retina procedures.