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Tip: Always verify insurance ahead of time

Ambulatory Surgery Reimbursement Update, August 19, 2008

It is very important that to carry out insurance verifications on every case performed in your ASC. Don’t assume that the insurance information given to you by the physician’s practice is always correct. Your facility’s reimbursement is in your hands.

Ensure you verify insurance for every case before the day your physicians perform a service. A common cause of claim denials is lack of insurance coverage for a patient on the date of service, which should never happen in an ASC. Since ASCs perform elective procedures, and not emergency cases, there is no reason that you can’t check benefits ahead of time to confirm coverage. At the time you check benefits, be sure the ASC staff members ask the question the right way. Give the insurance company the actual date of the surgery. If you are checking benefits late in the month for a case that your facility will perform early the following month and you don’t state what the actual date of service is, it may be problematic. If the patient’s coverage ends at the end of the current month and there are no benefits for the following month, you will need to go back to the patient for information on the change in benefits.

This tip is brought to you by Ellis Medical Consulting, Inc.

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