All these pieces of information are critical to successfully submit a claim for payment. If anything is missing, don’t expect to receive payment as claims with missing information are usually rejected before they even get to the payer.
Those claims that do make it to the payer with missing information are likely to be delayed and/or denied due to the missing information. You can avoid these claims payment obstacles by implementing a thorough patient registration process. Whether you give your patients a packet of forms to complete or have them input their information via kiosk, you will need to make sure you are asking for the right information and that you are accurately recording that information in your billing software.
Demographics include personal information as well as contact information. Often, the payer requires demographic information to exactly match the information they have on file for your patient. For example, Medicare will reject a claim if the patient’s name is spelled differently in their data base, the date of birth doesn’t match their files, and even if the generation is left off of the last name such as Sr., Jr., or III.
Gender is also a part of the patient’s personal information and can play a part in claim payment vs. denial. It may seem silly, but if the gender is accidentally recorded as the opposite sex, you could have claim denials because your diagnosis may not be appropriate for the sex of the patient indicated on the claim.
No less important than personal information is your patient’s contact information. Accurately recording this information can help reduce rejected claims as well as the obvious, providing a way for you to contact your patient.
Some payers will reject your claim if the patient’s address doesn’t match the address in their data base. When this occurs it’s usually because the patient moved and didn’t notify their insurance company or they notified the insurance company but not you. This problem can also occur because of data entry errors in your billing system.
Having accurate responsible party information, including patient’s guarantor and health insurance, is essential for getting your claims paid. Having correct health insurance policy information recorded in your patient’s account is a must as this will eliminate unnecessary claims rejections due to the payer’s inability to identify your patient as a member. When obtaining your patient’s health insurance information, remember to ask them about the policy holder because sometimes the patient is covered under their spouse’ or parent’s policy.
Often payers will require the policy holder’s name, date of birth, and relationship to the insured to be included on claims.
While some payers may allow the claim if just the patient’s information is correctly indicated, other payers will reject it due to invalid policy holder information. For example, Tricare will reject your claim if the policy holder’s date of birth is incorrect or missing even if the patient’s information is correct. Also, it’s important to remember to ask if your patient has more than one policy, and if so, which is the primary payer, secondary payer, tertiary payer, etc. Once you have obtained the correct insurance and policy holder information, you just have to make sure that you verify eligibility and accurately record that information in your billing system. Be sure to include the patient’s policy ID, group number (if applicable), policyholder information, and policy effective date. After collecting this information from the patient, you should verify that the policy is active and that the patient is covered for your services. Now that we know the patient is covered, all we need to do is add the insurance information to your billing system making sure to select the correct payer. Some payers may have multiple addresses for sending claims so you should be sure to choose the one indicated on the patient’s insurance card.
Finally, we need to gather information about why the patient has come for treatment. Were they involved in an accident? Was is an auto accident? Did they get hurt at work? Did they fall off a ladder at home while cleaning the gutters? When did this happen? When did their symptoms begin? These are all examples of information needed for billing claims.
If the service was provided to treat an injury, the claim must include the date of injury and must indicate whether the injury is related to employment, an auto accident, or other accident. If the injury is work related we need to determine if the employer is responsible for payment or if their workers compensation carrier is paying for treatment of the injured worker. If a workers compensation claim has been established, you will need to find out the claim number, the claims adjuster’s contact information, and where you should send the claim. All of this information should be collected during registration, verified, and added to the patient’s case information within their account.
Accurate registration is critical when it comes to getting your claims paid.
Just remember to ask for what you need, verify it, and accurately record it in your patient’s file. As long the information you’re sending is correct your claims will be paid.