Increasing Your Paid Insurance Claims Through Well-Trained Front-Office Staff

By Michael Carroll on February 22, 2016

Why do you get rejected EOBs? The reasons can run from an improper claim code to a mistake in patient information. Regardless of why the insurance company refuses to pay your claim, you’re stuck figuring out the reason and resubmitting in order to get paid.

But busy practitioners lack the time to get that done. That’s why AgniteHealth is a good option for so many ophthalmology practices and optical-related medical services. At least 30 percent of claims are rejected when they’re first submitted, but we can minimize that by ensuring that your submitted claims are coded right, with all the t’s crossed and the i’s dotted. Our review process can increase your acceptance rate to as high as 99 percent.

But there will still be rejected EOBs. The main reason why? In many cases, it’s a simple matter of failing to capture the patient’s correct information, including insurance eligibility verification.

Biggest Billing Mistakes In Ophthalmology

According to health care business organization AAPC, there are three main billing problems that result in rejected or denied claims:

  1. Incorrect or incomplete patient information. You must have every detail right for your patient, including the right spelling of his or her name, the right date of birth, the right social security number and the right insurance policy group number and subscriber number.
  2. Terminated policy. If the patient doesn’t have an active policy, it stands to reason that the insurance company will not pay.
  3. Services aren’t covered. The patient may not have a policy that includes optical coverage of any kind, so when you submit to the insurance company, they’ll reject the claim.

Importance of Front Office Staff

What’s the best way to reduce these mistakes? A properly trained and competent front office staff. Too many practices see the front office receptionist who checks in patients as just a friendly face, but in reality, that person is the first step in getting you paid quickly.

One problem is that there are few training programs for medical receptionists. Many people in this important position learn on the job, unless they were lucky enough to complete a one- to two-year program at a community college. It’s vital for the owners or managers of any ophthalmology practice to take time to train new hires in their most common duties and document correct procedures as a first line of defense against rejected insurance claims.

Hiring a new office staffer with the ability to quickly spot errors in medical records can be an advantage, too. Look for applicants with medical coding and billing experience or even a background in proofreading. An eagle-eyed receptionist can be the front line in minimizing common mistakes in medical records. Other key traits to look for in your medical receptionist candidates:

  • Good verbal and written communication skills.
  • Professional demeanor.
  • Good interpersonal skills.
  • Ability to multitask — handling in-person patients, taking phone calls and managing the reception area.
  • Organizational skills — ability to file, find information and keep to a schedule.
  • Technical ability — working the office machines, computers and phone system.

A top-notch candidate with abilities and experience may request a salary slightly higher than you’ve paid in the past, but you can make up the additional cost in efficiency and by having more insurance claims accepted.

Procedures for Verifying Patient Information

It’s not enough to hire the best people; you also need to instruct them on how to verify information. Asking, “Everything still the same?” for a patient is unlikely to fix any problems or changes with their information. You must train your staff to check the name, birthdate, address and social security number as well as insurance information for each patient before they are seen by the medical staff.

However, this isn’t as easy as verbally running down the list of information. Depending on how your front office is set up, asking for and receiving verbal information from patients can be a HIPAA violation. You may decide to print a check-in sheet and have a patient initial each piece of information before the appointment begins; be sure to have a procedure in place for securely destroying unneeded printed information. Or, you may use tablets or other devices to review the information with patients. In either case, you need to make sure that any communication is kept private to avoid any breaches of personal medical information.

As part of our verification process, we also check patient details for obvious errors like missing information or truncated numbers (for example, an SSN with eight numbers instead of nine). And we can work with you to straighten out any issues that come up, so you don’t spend time researching mistakes that can be quickly corrected and resubmitted.

What to Do In Case of Claims Rejection

If your practice has hired the right front office staff and created a policy for verifying all your patient information, you should see a drop in claims that are rejected due to an information error.

Because 60 percent of rejected claims are never resubmitted, quickly fixing mistakes and sending them back to insurance companies within the 60- to 90-day window of time when they will process the claim can prevent the loss of revenue that makes your practice profitable. We can help you with this part of the equation, as we’re set up to handle re-submissions in a timely manner and minimize your DAR.

The bottom line: You can reduce your unpaid claims almost completely with a two-pronged approach of hiring the best front-line staff and contracting with a fast and competent third-party medical billing service. Contact us for more information about how we work and what we can do to save your practice time and money.