• E-mail
• Print
• RSS

Verify insurance functions

Patient Access Weekly Advisor, October 24, 2007

Want to receive articles like this one in your inbox? Subscribe to Patient Access Weekly Advisor!

Insurance verification and authorization functions involve many factors. With hundreds of differing insurance plans and varying requirements, the analysis of these two functions was the most time-consuming and intensive piece of the staffing model development for Houston-based MD Anderson Cancer Center.

MD Anderson sees approximately 26,000 new patients each year and schedules and financially clears about 1.8 million outpatient appointments.

For the insurance verification function, a team was designated to categorize each insurance code into the method of communication the staff member used. MD Anderson created three categories-phone, fax, and Internet.

Tasks included reviewing the system information, communicating with the payer, and documenting the results in the computer system. Many patients have multiple insurance plans, so the hospital also factored in secondary insurance plans.

The team calculated and summarized the workload for each plan to account for the effort put forth for an average patient.

Based on the insurance plan, MD Anderson reverifies patient insurance eligibility on a 30- or 60-day cycle. Unlike most hospitals, MD Anderson's patients are not coming for episodic care. Its patients return almost daily for services. The model has the flexibility to adjust the time period between insurance eligibility verifications as policy changes dictate.

Provided by Connie Longuet and David Bivens

Want to receive articles like this one in your inbox? Subscribe to Patient Access Weekly Advisor!

• E-mail to a Colleague
• Print
• RSS
• Archive