Rehab

Don’t let insurance authorizations jeopardize your reimbursement

Rehab Regs, August 19, 2004

A solid game plan for avoiding insurance authorization mistakes begins at the registration desk, says Angie Phillips, PT, president and chief executive officer of Images & Associates, a healthcare consulting company in Amarillo, TX.

The following are five tips from Phillips and Mark Brimer, PhD, director of rehabilitation at Wuesthoff Health Systems in Rockledge, FL, to help ensure that you get the information you need to receive adequate reimbursement:

Find a flagging system that works for you. Whether it is a manual or electronic system, make sure that both business office staff and therapists know how to determine each patient's remaining benefits.

Keep abreast of contract changes with insurance carriers. Most carriers negotiate contract changes annually that take effect January 1, says Brimer. "It's important for managers to stay informed about changes to contracts and pass them down the line to other staff members," he says.

Make a cheat sheet for the most common insurance carriers. Chances are that your outpatient rehab facility has a handful of insurance carriers that staff members deal with on a regular basis. Make note of their authorization criteria and past it where staff can reference it easily.

Ensure therapists know what the office staff is doing, and vice versa. This is essential to keeping your flagging system up and running. "The key is routine communication between business office staff and caregiver staff," says Phillips.

Always check for any necessary reauthorizations. After granting authorization for the initial evaluation, some insurance carriers require therapy facilities to obtain reauthorization to provide the actual treatment. If this is the case for your patient's carrier, you may even be required to provide it with evaluation notes before it will grant the reauthorization. Also keep your patients informed about how many covered visits they have left for treatment, says Brimer. As a last resort, you could have patients who are reaching the end of their coverage call their insurance carriers to stress the benefits they receive from rehab treatments.

Remember, if you provide treatment to your patients beyond what their insurance authorizes, you cannot bill them for the uncovered services. Your facility will have to absorb those costs. But if your staff stays on top of authorizations, claims denied for this reason should be few and far between.

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