As we approach the new calendar year, now is the time to look ahead and ensure that your home infusion or specialty pharmacy’s intake and billing teams are ready for insurance policy changes in 2020. Here are three tips to prepare:
1. Verify deductibles. At the start of each year, most insurance company deductibles reset, and patients with high-deductible health plans (HDHPs) must meet their deductibles before their new health plan can cover their medical costs. This means that in the beginning of the year, providers often need to collect from patients more than payers. Verifying each patient’s benefits prior to providing service allows your organization to collect payment or create a payment plan to prepare for the patient’s upcoming responsibility. This practice can also prevent a negative experience if patients receive an unexpected bill.
2. Determine if policy ID numbers have changed. If there are changes to policy numbers or alpha prefixes, these changes will affect prior authorizations. If you have identified policy changes for patients that have active authorizations spanning into the new year, you should ask the insurance company to transfer authorizations to the new policy. Proactively verifying both policy ID changes and authorization transfers will help you easily transition claims processing in the new year.
3. Take out the stress and have a happy new year! Make sure you’re ready to manage the details of year-end. Billing in 2020 doesn’t have to be challenging when you prepare and proactively eliminate the headaches of increased denials, days sales outstanding (DSO), and potential bad debt!
Happy New Year from the entire WellSky team!