Case Management

Tip: Long list provides many reasons for incorrect insurance information

Case Management Weekly, July 18, 2012

Discharge planners generally are not involved in the registration process, during which patients identify their insurance coverage. However, clinicians commonly become aware of erroneous or missing insurance information. When clinicians discover new or erroneous information, a correction must be entered into the hospital’s billing system. 

Examples of sources of erroneous insurance information include the following:

  • Emergency department patients who are unstable due to injuries or unable to locate their insurance information
  • Patients whose coverage recently changed (e.g., eligibility for Medicare)
  • Newborns not yet enrolled in parents’ policy, especially when both parents work and have coverage (rules determining coverage vary by state)
  • Patients whose coverage is terminated due to divorce
  • Patients who are unable to provide current healthcare coverage information
  • Patients whose spouses have recently changed employers and are unaware of their own healthcare coverage
  • Patients whose eligibility for end-stage renal disease coverage is changing
  • Patients who receive workers’ compensation benefits and are admitted for a medical condition unrelated to the compensation benefit, or who have ongoing needs related to a workers’ compensation injury that have been complicated by the medical condition 

This tip is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition published by HCPro, Inc.

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