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
