Avoid patient coverage surprises after Open Enrollment

December 5, 2016 ABILITY

Open enrollment can create uncertainty and costly oversights for every healthcare provider. Premiums have already increased for the 2017 enrollment period, although major changes to the Affordable Care Act may take time to materialize. More immediate proposals for payment increases for skilled nursing facilities means the time to be aware of your options is right now. If you fail to detect a change in a patient’s coverage, the consequences can be severe, including delayed or even denied payments. When a patient changes health insurance and the new health plan denies reimbursement, you face an unpleasant choice: surprise the patient with a bill, or write off your services, costing you money.

A breakdown in communication can often lead to issues, and there are a number of reasons why patients might not inform healthcare providers of a change in their coverage, including:

-They’re going through a very stressful time, and that detail falls through the cracks.

-They may assume a new healthcare plan will communicate with their healthcare providers.

-Family members or other caregivers may be involved, making it harder to communicate directly.

-They may fail to understand the importance of giving their healthcare providers their up-to-date insurance information.

-They don’t know basic facts about health plans.

Conversely, there are a number of reasons why billing managers fail to discover a change in coverage for their patients. One of the biggest challenges is that eligibility verification is not always done properly at the time of admissions.

What you can do

There are a number of methods you can start using today in order to begin this conversation with your patients. The first step is figuring out how you identify these changes so there is no delay in revenue. Key in this is working with your patients to ensure clarity and full understanding of any changes to their plans. Emphasize the importance of discussing changes in their coverage, or consider using automated recurring verification, which is often a successful approach for many providers.

ABILITY can help you prevent re-billing and write-offs and help make eligibility confirmation easier for you. To learn more, visit the Open Enrollment section on our Resource Center, or contact us to discuss your individual needs.

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