What Online Tools Do You Use
Published April 13, 2011 | 
What Online Tools Do You Use for your patient registrations? Utilizing whatever tools you can to ensure that you get accurate and timely information on ALL of your registrations is important for you keeping your job as well as making sure that your company stays in business. With the advent of the Red Flag Laws we are required to ensure that our patients are who they say they are. There is also the the ever increasing problem of patients seeking medical care just to get prescriptions for drugs who will tell you wrong information. This is especially true in Emergency Rooms across the country and with the EMTALA ruling we are required to treat patients regardless of their ability to pay. I am not advocating turning patients away or making them wait a long time for service but you should treat each registration of the patient as a new patient and confirm everything when they come in as well as ask for positive ID and their insurance cards. You cannot get a 100% accuracy rate but you can come close.
To that end we use a variety of online tools to ensure that the information we get from patients is current and accurate. To verify a drivers license you can try online verifications offered through your state’s DMV. To verify addresses you should try the postal service www.usps.com by putting in the address but not the zip code. They will tell you if the address is valid and deliverable. You should also try a reverse directory website for checking phone numbers and addresses. One of these that does not charge is www.whitepages.com. And you can use your county’s property appraiser’s website to verify an address and the owner.
Lastly, you should considered purchasing and using on online insurance verifications website such as Passport and Emdeon. Passport has the ability to verify social security numbers and have a wide variety of payers as well. They also have a payer address and claims information database that is fairly decent. WebMD or Emdeon is a very nice service as well. Now these are pay-for-use services and you will have to negotiate your own rates with them. You can also take advantage of the free services offered by each of the major insurance carriers. Availity is offered by our Medicare intermediary for free to Medicare and Blue Cross providers. Of Course, Tricare has an online eligibility verification system that is free to providers. United Healthcare offers their providers with online verification as well as the ability to view their insurance cards should a patient forget to bring one with them.
These are just some of the many tools available for Patient Access Reps or Insurance Clerks (whatever term your employers uses for Registrars) that can be used to help you do your jobs effectively and efficiently. It will also help your billing and collections department do their job in a timely manner. The name of the game is to ensure accuracy of information, entering information into your computer system correctly and make sure that the claims go to the right insurance as quickly as possible to get the money back.
Visit Insurance Websites
Published February 16, 2010 | Almost every major insurance type has a main site that is just filled with free information for the Patient Access Representatives as well as their customers. Most companies are required to tell you about their requirements for billing, precertification, etc. Visiting their websites and going to the provider section should net you a billing manual and contact information to followup with claims, notify them for precertification and where the claims should be going. Getting the right information the first time is what we should strive to do. This will decrease our Accounts Receivable Days and bring the money in quicker. This will make the management people happy and may translate into more money for your pocket in the form of raises. I don’t know about you but getting paid is why I go to work.
Medicare has a great site with loads of information. There are several states that have more Medicare patients than others and if you are in one of them then going to the www.medicare.gov website is essential. Of course, those will Railroad Medicare have their own site at: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Railroad%20Medicare~Resources
If you have a large military base in your area then you really should go to the Tricare Site for Your Area. There are three of them depending on your state. Tricare West is http://www.triwest.com/provider/. Tricare South is http://www.humana-military.com/south/provider/provider.asp. And finally Tricare North is http://www.tricare.mil/tma/providerinformation.aspx
Every state has their own Medicaid site. To Find yours you can go to your favorite search engine and type in your states name and then Medicaid or you can go to the Federal Medicaid site and you will get the Federal Guidelines that all states must follow and find the links for each of the states as well. The Federal site is at: http://www.cms.hhs.gov/home/medicaid.asp. To find all the state sites in one place go to this website: http://64.82.65.67/medicaid/states.html.
These should get you started and next month we will get you more information about other insurances!
EMTALA – Emergency Medical Treatment and Labor Act
Published March 3, 2009 | EMTALA is the regulation that governs how we interact with our patients in a Medical Facility. The Act has several provisions but most if not all but one apply to the medical treatment team and case manager. The only section that applies to Registration comes under Delay in Examination or Treatment section and states the following: “Hospitals may follow reasonable registration processes for individuals for who examination or treatment is required by this section, including asking whether an individual is insured and, if so, what that insurance is, as long as that inquiry does not delay screening or treatment.
Reasonable registration processes may not unduly discourage individuals from remaining for further evaluation.” The first part just means that we have to wait until the patient is alone before we start the registration process and if the nurse, doctor, X-Ray Tech, EKG or any other medical personnel come into the room we have to stop and come back later. The second part of the requirement is a little more tricky. How do you ensure that the patient is not unduly discouraged from continuing with further evaluation during the registration process? The key is to be courteous and professional with all the patients. Answer any questions that the patient may have about the billing process to the best of your knowledge. If there are any questions that you do not know assure the patient that you will find out the answer and provide it on discharge.
We are not allowed to ask for copays until the patient has been stabilized so it is best to get the copays on discharge as we are not medical personnel and will not know when that happens. Also, if the patient is admitted to the hospital then another copay is probably due for that type of service and in some cases none is due at all. That means that you will have to reverse any credit charge or give back any check or cash collected from the patient before they leave for the floor.
Knowing when to go into a patient’s room is always hard and depending on your medical personnel may be close to impossible. You, as registrars, are not medical personnel and cannot know when the patient has been satisfactorily accessed per EMTALA guidelines and if the patient has been medicated with certain types of drugs the authorization signatures may not be valid. Yes, we have “IMPLIED CONSENT” but from all my readings that just covers the actual treatment of the patient and not all of the various financial authorizations that we have to get signed. My best advice is to develop a rapport with your emergency room doctors and nurses and be courteous of them and asked them when it is okay to procede with the registration process.
If all else fails you can get most of the information you need from the patient’s relatives if they are available, facesheet from the sending facility if the patient came from a nursing home or another hospital, the rescue “Run Sheet” usually has preliminary information you can use until the patient is coherent or family arrives. Lastly, utitilize your online verification systems when you can. I recommend Passport for some insurances. They offer a variety of different insurances for verification purposes is almost never down except for when that particular insurance is not accepting inquiries but most of all they offer a Social Security Address Check Feature! This feature is a great place to start if your patient has never been to your hospital before. The information is taken from one of the credit bureaus so is as accurate as the patient allows it to be but it is a place to start. And with a social security number and birthday you can check some of the major insurance companies for coverage such as Aetna, Medicare, and Medicaid. They also offer an Insurance Database with name, address and phone number of almost every insurance in the United States! This feature comes in handy when you have an insurance card with no claims address or the patient can only give you the policy number and the name of the insurance. If you don’t have access to an online insurance verification system I highly recommend you get sign up for one. Yes, there is a cost involved with most if not all of them but they will pay you back with information you may not otherwise have access to.
For those who do not wish to pay for access to insurance verification through a third-party vendor such as Passport or WebMD then you should at least sign up with the insurance companies that you are contracted with. That means for each insurance company you have a contract with most will have an online provider service that you can sign up with for free! All you have to do is fill out the paperwork and go through whatever verification process they require and then you sign-on the website and verify your patient’s insurance, get referrals and precertification and some even have claims follow-up.