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Improved Eligibility and Authorization Requests Solve Collections Problem

Improved Eligibility and Authorization Requests Solve Collections Problem

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If you thought patient debt was already high, it is about to get worse. In 2010, patient debt was $65 billion dollars, but it is projected to rise to $200 billion in 2019. Between employers offering higher deductible plans and 10-15% of claims being denied, patients can’t pay their bills – and medical facilities can’t collect payment.

At times there are errors in collecting patient information, which leads to insurance companies denying claims. But by improving both eligibility and authorization requests, requests can be processed without error and on-time.

Let’s take a look at how some long-term acute care hospitals currently process eligibility and authorization requests:

  1. Patient is scheduled for admission evaluation. Benefit verification indicates that authorization is required.
  2. Revenue Cycle Management (RCM) notify Case Management staff by phone or email to capture insurance information and obtain authorization data.
  3. Case Management staff manually documents patient insurance information and authorization data.
  4. Benefit information and authorization is delayed or not accurately captured.
  5. Claims are denied and patient debt goes uncollected.

Because patient information and authorization data is entered in manually, mistakes and typos are bound to happen. But by using TigerConnect Clinical Collaboration Platform – Standard to record the information, the correct information is gathered the first time.

Let’s take a look at the same communication path but with TigerConnect Clinical Collaboration Platform – Standard incorporated into it:

  1. Patient is scheduled for admission evaluation. Benefit verification and authorization is required.
  2. RCM staff notify Case Management staff via TigerConnect Clinical Collaboration Platform – Standard to capture insurance information, copy card and obtain authorization.
  3. Case Management staff send photo of insurance card and photo of authorization form to RCM Staff via TigerConnect Clinical Collaboration Platform – Standard.
  4. Benefit information/authorization verification is received in a timely and accurate manner reducing denials and improved authorization requests.

By taking these proactive approaches to eligibility and authorization requests, healthcare providers can use screening tools to assess a patient’s financial responsibility estimate, and then set up patients with financial counselors to work out a payment plan when necessary. Less claims are denied, and patients see a decrease in debt.

Moreover, by driving improvements in understanding eligibility and benefit requirements, healthcare organizations can improve the costly process associated with retrospective reviews and requests for appeals for denied claims.

Want to learn how this communication path can work within your organization?

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Will O’Connor, M.D. is the Chief Medical Information Officer at TigerConnect. As a physician executive with more than 20 years of healthcare experience, Will is a passionate advocate for rapid advancement across the healthcare industry.