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
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
