Service may not be covered? Tell patient
If a pre-certification is required prior to service, registrars at TriHealth in Cincinnati do everything in their power to be sure it's obtained. However, if this is not obtained prior to service, employees are required to get a Notice of Non-Coverage signed, reports Stacey Bodenstein, general manager of admitting and registration.
"Typically, the patient is made aware that this will be required before they come in for services by either their physician or our insurance verification department," Bodenstein adds.
Registrars use this script when asking for the Notice of Non-Coverage to be signed: "You are being asked to sign this letter agreeing to pay for your services if your insurance company does not because ____________________."
If the patient refuses to sign the form, registrars document this information and scan it into the account, but treatment is not refused, she adds. "Staff state the reason they are being given the notice, such as no precertification or no coverage," says Bodenstein. "We also offer a booklet that explains it in more detail."
Auths obtained
TriHealth's insurance verification team works closely with payers to obtain authorizations prior to the date of service. "As payers are requiring more and more services to be pre-certified, this has become an even greater challenge," says Bodenstein.
To keep staff updated with payer requirements, TriHealth's patient access department uses software that interfaces with its health information system. "When payer requirements need to be updated, we can program it to guide the registration employee to the new payer plan," says Bodenstein. "We also send out e-mails explaining each change to keep all registration employees informed."
The software allows the department to make changes quite easily, says Bodenstein, "but unfortunately, we still have to find out that we are doing something wrong before we can make corrections. We work closely with our patient accounting department to stay 'in the know' about upcoming changes."
If a pre-certification is required prior to service, registrars at TriHealth in Cincinnati do everything in their power to be sure it's obtained. However, if this is not obtained prior to service, employees are required to get a Notice of Non-Coverage signed, reports Stacey Bodenstein, general manager of admitting and registration.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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