January 01, 2016
Advisory Services Supervisor Elizabeth Deak's article, "A collaborative approach to ongoing benefits verification," appeared in the January issue of HCPro'S Billing Alert for Long-Term Care.
Admissions department and billing office staff know the importance of verifying benefits for prospective residents. By establishing a procedure to evaluate a beneficiary's payer source prior to admission, SNFs can reduce possible claims adjudication issues and facilitate the receipt of payments in a timely manner.
With beneficiaries increasingly enrolling in new healthcare programs, it's becoming essential to supplement preadmission verification with periodic reviews of payer information throughout a resident's entire stay (e.g., on a monthly basis). Recognizing the value of ongoing verification, knowing the right questions to ask, and documenting findings will help SNFs avoid any hiccups on the road to reimbursement.
To kick off verification activities, providers should obtain copies of a prospective resident's insurance cards, and, if the resident is a Medicare beneficiary, a copy of his or her supplemental plan card. Beyond this requisite collection, specific verification measures will often depend on the combination of plans a beneficiary holds. The following sections outline key considerations for common SNF payer types.
This article appears in the January 2016 issue of Billing Alert for Long-Term Care, a monthly newsletter for Platinum members of HCPro's Billers' Association
for Long-Term Care.
For more information or to become a member, visit www.hcmarketplace.com/billers-association-for-long-term-care.