5 Tips for Faster Insurance Reimbursements

5 Tips for Faster Insurance Reimbursements  

By Nancy Mura, Senior VP Public Relations

Ah, insurance. It helps so many people get the therapy they need. But for the provider, especially the small-to-medium-sized PT/OT/SLP clinic, insurance can be frustrating, challenging and disheartening. 

Because we want you to not just survive but thrive, we’re going to provide you with vital tips on getting what you need and deserve from insurance companies.

• Tip #1: Adopt a new mindset: Don’t ever let yourself feel beaten by insurance companies. Never allow yourself to think that nothing can be done about their complexities or denials. Instead, become resolute in your efforts to get paid all the claims you rightfully deserve. A resolute attitude will carry you through the barriers to payment and enable you to bypass the frustrations.

• Tip #2: Collect all the information you need right at the start. Each time you get a new patient or when a patient’s insurance coverage changes, collect all their pertinent information. For example:
  • Correct spelling of patient’s full name
  • Correct address and phone number
  • Policy and group numbers 
  • Correct contact and filing information for the insurance provider
  • Other vital information such as date of birth

Remember, the slightest error enables the insurance company to deny the claim. So, ensure that staff always double-check spellings and numbers. It is smart to keep a notice up at the front desk or waiting areas that patients should inform staff as soon as insurance coverage changes. 

When you have all this information, find out exactly what the insurance provider’s billing procedures are before you send them a single claim.

• Tip #3: Determine payment responsibility. Before treatment starts, contact the insurance company to determine who is responsible for what costs. What are the patient’s co-pays? Which of your services are covered and which are not? You need to know right at the start of treatment which services your patients have to pay for themselves. To prevent upsets, you need to brief patients or a pediatric patient’s parents on the charges they will be responsible for before treatment starts.

• Tip #4: Make sure the claims you file are 100% accurate. As mentioned above and as you have probably noticed, insurance providers will pick any small detail that is in error and deny the entire claim. The accuracy of your claims is 100% up to you and your staff. You must make your expectations crystal clear for your staff: only 100% accuracy is acceptable. That includes all of the information listed in #2 above as well as diagnosis and treatment information. Plus your diagnosis and treatments must exactly match the billing and coding you forward to the insurance company.

• Tip #5: Follow Up Vigilantly: You provided the care, the patient received the benefit and you deserve the payment. Establish the policy that every claim that is held up, partially paid or denied outright, is followed up aggressively and promptly. Find out exactly why the claim was denied and handle the problem.
  

It would be nice if these tactics weren’t needed but this is the world we are currently living in. You deserve full payment for the care you deliver and your patients deserve the full coverage they are entitled to. Just understand that these are the steps you’re going to have to take to consistently get fully paid. Hopefully, that philosophical viewpoint can help you avoid frustration.

If you’re struggling to establish viable financial policies and procedures that work, contact Survival Strategies at 833-221-8002. We can help calm the waters.