Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, suggests following these five guidelines to help your ASC perform proper patient insurance verification.
1. Don't depend on on-line eligibility status. Call the payor directly.
2. Use a verification form so no important information is forgotten. Capture information including:
- Medical necessity (ASCs cannot determine medical necessity, only physicians)
- Second opinion required
- Deductible / co-pay amount
- Lifetime limit
- Preexisting condition
- Preauthorization codes
- Claims address
- Out-of-network benefits
3. Verify all applicable insurance plans. This includes primary and secondary insurance. Make sure you determine which is primary.
4. Verify coverage a minimum of two weeks in advance if possible. For late add-ons, verify as soon as possible. Medicaid requires verification too — usually online.
5. Document all information in the appropriate section of your software.
Learn more about Serbin Surgery Center Billing.
Read more practical guidance from Caryl Serbin:
- 8 Best Practices for Contracting With the Right Insurance Plans
- 14 Recommended ASC Business Office Reimbursement Policies
- 7 Quick Guidelines to Follow for Successful Collections