New Year, New Benefits
Written By: Kara Fischer - Director of ABA Client Services at Keystone Medical
The New Year is a time for possibility and change; an opportunity to reset. Do you know what also resets in the New Year? Insurance Benefits. It’s the time of year where most insurance policies update their ABA benefits, including resetting deductible and out-of-pocket cost share accumulators. It’s also a time where many families change insurance coverage. Planning for these changes is particularly critical for ABA services, due to the frequency of encounters and payer requirements. Failure to prepare may find you scrambling to obtain authorizations, creating denials, or reducing reimbursement. So how exactly do you prepare? Today we’re sharing four workflow ideas that will “benefit” your organization and clients this year.
Communicate
One effective way to collect the information you need is to create an open line of communication between families, clinicians, and your billing/authorizations department. Here are two ways our team creates communication opportunities with families:
Our team conducts annual Financial Advocacy Calls with each family. During this call, we educate families on their benefits, potential cost-share, and discuss the importance of great communication about changes in insurance coverage or benefits. When families understand why it’s imperative to communicate insurance changes, they become partners in the reimbursement process.
Twice a year, in June and December, we send families a Verification of Benefits packet to review and return. Some elements to include:
An area for the responsible party to review or update insurance policy information and coordination of benefits. Information collected here includes policy name, subscriber ID, group number, mailing address, and contact phone numbers.
Financial policies and fee schedules. Outline your financial policies and fee schedules, and include a space for the responsible party to sign.
Clear guidelines and expectations around payment plan options and collection policies and timelines.
Pro Tip: If a family does communicate a change in insurance, it’s a huge time saver to get a copy of the front and back of their insurance card. The insurance card will often show specific network participation information and include direct phone numbers for benefit verification and authorizations.
Verify
Improving communication with families can drastically improve your benefit verification process and billing workflows. However, sometimes families provide incomplete or inaccurate information, or are unaware of important changes. Consider performing an internal benefits review for all clients, regardless of reported changes. During our annual re-verification for one of our partner organizations, we discovered nine clients whose insurance had termed at year end and four who had significant benefit changes to their policy. This re-verification prevented countless denials and helped our clinicians avoid unnecessary retro-authorization paperwork. (For more on preventing denials, click HERE.)
Authorize
Insurance policy updates can often mean new or updated authorization requirements. While most insurance companies will backdate authorization requests to ensure continuity of care, some will not. In the event that a retro-authorization request has to be submitted, it is critical to communicate with the family. If the payer will not backdate the authorization request, this could result in an additional out of pocket cost. This scenario can be a great opportunity to illustrate the importance of notifying the organization of insurance changes in advance to avoid a lapse in care or additional out of pocket expenses.
Pro Tip: Note when the most recent treatment plan was created. If the treatment plan was created over 60 days ago, you may need to procure a partial authorization. Some payers will allow a partial authorization to go through the intended end date of the original authorization. This allows the clinician time to perform an updated assessment and treatment plan. Including a cover letter with the requested authorization, emphasizing the importance of continuity of care, can lead to a higher approval rate for these exceptions.
Communicate (AGAIN)
If policy changes occur during the year, we suggest scheduling a new Financial Advocacy Call with the family. This creates an opportunity to explain updated cost share information and policy requirements. Families appreciate knowing the financial impact a new policy might have. For families with a large cost-share, consider creating a new payment plan with the responsible parties, helping to reduce stress for them, and reducing your outstanding patient AR later.
THE TIME TO START IS TODAY
Whether you’re reviewing your benefit verification process in January or June, the time to start is today! If you’re inspired to transform your benefit verification workflows but need a kickstart, reach out to us HERE to learn more about the services and support we provide nationally to ABA billing teams, BCBA’s and beyond.