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The Foundation of a Great Financial Department

3rd Party Billing and Collections
Rhonda Hodge MCS-P
in 3rd Party Billing and Collections
By Rhonda Hodge MCS-P

Chiropractors emerge from school ready to take on the world

Financial Foundations

However, most new chiropractors quickly realize that training on the business side of practice hasn’t received adequate attention. That is particularly true in the areas of reimbursement and compliance. The final trimesters or quarters in school are largely devoted to caring for patients. Precious little time is available in these final periods to really learn about business. When new graduates accept their first associateship or open their own practice the real world rears its head. Bills need to be paid, student loans come due, and the day-to-day grind of billing and collection becomes a reality.

There are two important elements that affect practices that work with patients’ insurance. These are the insurance verification process and the nuances of patients’ insurance cards.

Isn’t there an easier way?

As a specialist with an extensive background as a Chiropractic Assistant (CA), I know that verifying insurance can be a cumbersome task. Even with online options, interactive voice response systems (IVRs), and the old stand by of actually speaking to a person, this task still takes a chunk of time out of your CA’s schedule. You may not get all the detailed information necessary through online sites, especially when offering services beyond adjustments. Many carriers require that you call the automated system before speaking to a representative to retrieve additional details. If this does not yield the necessary information, your next step is to speak to an actual person for the final details. All of this can be very taxing on an office of any size, particularly if proper procedures are not in place to streamline the process.

Every good chiropractic business is built on cash flow. The provider can treat patients all day long, but unless the Financial Department fully understands how to collect from either insurance or patients, your office will likely struggle. The verification of benefits is the foundational element for the Financial Department. This is true whether you are in network or out of network with carriers. You may consider your practice a strictly “cash only” office, but if you treat patients that wish to submit services to their insurance, even though you are out of network, you will not truly be “cash only.” It is imperative that you and your staff know how to interpret the information provided on an insurance card and how to utilize that information to verify the benefits of the insured individual.

Too many cards… And some look alike

There are a vast number of insurance carriers out there, and the information on patients’ insurance card does not always follow the same format. They don’t necessarily look alike but generally provide similar information. Below is a list of the common elements:

  • Insurance Carrier name
  • Insured Individuals name
  • ID number
  • Policy number
  • Effective date
  • Co-pay
  • Group ID
  • Types of groups with policy (such as prescription, dental, etc.)

Often, the back of the card will contain phone numbers, billing addresses and/or payers’ id numbers.

All of this is vital information. It ensures that the provider understands the patient’s insurance and provides access to the patient’s benefit coverage. All too frequently something gets over looked because the staff has not been properly trained on how to read the myriad of different cards and how to interpret the important details on each. Current technology, and the ease of using Google, make it possible to view all the details in some format. The use and understanding of this technology will increase your staffs’ ability to comprehend the information included on patients’ insurance cards.

This becomes especially important when you factor in Medicare Advantage (aka Medicare Part C or Medicare Replacement) cards. Because Medicare Advantage carriers can be the same (or at least appear that way) as a Major Medical Carrier (like BCBS, Aetna, or UHC), you can see the importance of understanding this element in order to avoid the incorrect assignment of patient responsibility.

Why Verify?

Verification is a simple, yet time consuming step that sets the tone for every other financial transaction between you and the patient. It provides a clear picture of who is responsible for what portion of patient charges. After conducting the Report of Findings (ROF), where the patient’s recommended treatment plan is clearly explained, it is easy to smoothly transition to the Financial Report of Findings (FROF) where the payment and participation of the insurance company is explained.

Once these two critical steps are complete, the patient’s progression through the treatment plan can proceed with ease. Clear financial understanding contributes to a great patient relationship and that fosters excellent patient compliance with your recommendations. Clear verification makes it easy for the financial team to know exactly what should be collected from the patient at each visit or on what payment schedule. Meanwhile, your biller can be confident that the billing to the insurance company is correct and will understand what can be expected from that carrier. Should a payment or EOB state anything different from what the verification stated, the staff member can now contact the carrier to inquire. Since they began with a verification process, they can confidently explain the specific information they were quoted and thus resolve the issue.

Of the various reimbursement systems that should be installed in your practice, one of the most essential is the new patient reimbursement system. Think of each step in this process as a tooth on the cogwheel that runs this department. Verification is clearly among the most important steps in this process. Granted, we live in a fast-paced society and the tendency is to take the quickest and easiest way to do things, but skipping insurance verification can have an enormous, negative effect on the financial health of the practice.

Visit the KMC University Library to find multiple lessons on insurance verification, and our myriad of verification forms, including major medical, Medicare, Personal Injury and Worker’s Compensation. We’ve done most of the heavy lifting for you, outlining the most important questions to be asked in each category. Not a member? Click here for a free demonstration and to check out the verification forms for yourself.