Insurance Verification Paramount

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If your office accepts insurance, it is vital that you start with an Insurance Verification Form that is tailor-made to your practice. The purpose of this form is to verify benefits (or the lack thereof) and to make patients aware of their coverage and ultimately what their responsibility will be for any unpaid balances. Just because an insurance company tells you that your patient has coverage, it does not mean everything will be covered. A properly worded verification, executed in a knowledgeable manner, will eliminate most surprises come payment time.

While there are many questions that can be asked and which apply to all offices, some are clinic-specific. After inputting the date and time you called the insurance company to verify benefits (absolutely necessary to ensure your appeal rights in case they misinform you with regard to coverage), and once you have ascertained all the other important information, like whether or not preauthorization is required, chiropractic limitations (including dollar, visit, and modality per visit, etc.), and to whom payment is sent (even if you accept assignment, some plans still pay the patient), you should have a list of those CPT (Current Procedural Terminology) codes that are unique to your practice.

What I do for my clients is list eight to 12 specific CPT codes at the bottom of the form. This way, they can breeze through the preliminary data, and then move on to those codes that separate their specialties from the norm. I have also formatted the insurance verification form to enable the Chiropractic Assistant / Coding and Billing Agent, etc. to tab between the fields, so they can easily enter data with their two free hands, while using a headset.

Furthermore, since many patients have the same insurance, you can save one master verification form as a template for each type, e.g.Aetna, Blue Cross, Cigna, etc. Better yet, if they have the same group number, you can pre-fill out even more of the form and save it by insurance name and group number.  For example, if you have multiple patients from the same employer who have the same insurer (let’s say Aetna) and the same group number (let’s say 123456) then you could save a master insurance verification form template as “Aetna Group Number 123456.” Then, when someone from that employer comes in for the first time, you merely open the template “Aetna Group Number 123456” and you will have most of the information already filled out. Since it is saved as a template you will not have to worry about overwriting the master file, as it will prompt you to save it as a document.

There is one caveat, though. Just because employees have the same group number, it does not mean the benefits are identical. Consequently, you should always leave blank those areas that change from patient to patient. After a few calls on the same company’s employees, you will know what always stays the same and what is variable from patient to patient. For instance, during the insurance verification, we discovered that one company’s employees all had the same insurance and the same group number.  However, there were different levels of coverage and different deductibles, as well as different chiropractic limitations. Consequently, we left those areas blank on the insurance verification master, as they changed from patient to patient.

Remember, a good insurance verification starts with a good insurance verification form. Make yours the best it can be by tailoring it to your practice and its specialty. You and your patient will be the better for it!

Next time we cover the ChiroCode Institute, their Premium Service, and why no clinic should be without it.

Edward M. Tucker codes, bills, and works on appeals for clients in Arizona and Florida. Ed has worked in both Chiropractic and Medical Offices since 1996. While Ed has performed coding and billing for medical doctors, optometrists, and psychologists, his passion is Chiropractic, because he sees it as the “ounce of prevention that is worth the pound of cure.” He has also taught Medical Coding and Billing, Introduction to Allied Health, and Medical Office Procedures, among other classes, at a local college in West Palm Beach, Florida. Additionally, Ed is a textbook reviewer, and has completed three assignments for Prentice Hall/Pearson Publishing. One of his greatest accolades came just this year, as he was listed in the current edition (17th) of the ChiroCode DeskBook in the Acknowledgment section for his ongoing work on various “chirocentric” projects. He is a graduate of the University of Alaska, Anchorage, with a B.A. in Political Science.
To contact Edward M. Tucker - Coding / Billing / Appeals Consultant
Phone: 561.687.4427
email: edwardmtucker@aetserve.com