In an attempt to get the answers you need, first you must make sure to ask the right questions. This concept applies to billing in so many ways. How do you make sure that you get the answer you need and not the answer to the question you asked?
When a patient presents to the clinic for a visit, standard protocol is to confirm their demographic information, including their current insurance coverage. If you were to ask the question ‘are you still at the same address?’ the likely response is ‘yes’. However, depending on how long it has been since their last visit, what is listed in the system may/may not be accurate. If you were to ask the question ‘what is your current address?’ the patient is now prompted to provide the exact information, affording a greater opportunity to actually confirm that what is listed is accurate. When you ask to see the patient’s insurance card as opposed to asking ‘do you still have insurance x?’, now the information on record can be confirmed for accuracy and/or offers an opportunity to update necessary information to ensure payment. As employers change benefit packages, the carrier may be the same, however, benefits may often change.
What kind of response would you receive if you asked ‘does Medicare cover home health certification?’ The answer would be yes, this is a covered service. However, without the proper context and question, the answer provided does not afford the most appropriate information to determine next steps. While home health certification is a Medicare covered service, in an FQHC it is not a billable service. There is no face-to-face encounter to qualify as a billable visit. If failing to mention the type of provider when asking the question or following with pertinent details, the information obtained is incomplete.
These are just a few simple examples but more often than not, I find myself asking a question in response to receiving one…just to better understand the context and direction of the conversation. Basic principles of troubleshooting apply – who, what, when, where, why and how? If you can’t truly understand each of those, it is difficult to provide the most accurate response.