Centralized Insurance Verification and Authorizations Boosts Collections

Insurance Verification and AuthorizationsAt OSI, we often tout how we like long term relationships; and we mean it. We have been working with a national oncology research, consultations and treatment company with multiple clinics. Currently, they have 120 offices organized into 8 regions. We have been working together for over one year and are coming up on our 2nd anniversary of providing service.

Challenge

This client contacted us in early November 2010, responding to our “virtual front office” service. They needed help getting their insurance verification and authorizations centralized. As oncology consultations and procedures are involved, one might imagine that the insurance and coding would be “interesting” as well as critical to their operation. Initial estimates on volume were 20,000 consults per year, which proved to be accurate.

Given the nature of the care and to develop a list of the information needed for verification and authorization, we needed to create a protocol to obtain the correct information from insurance companies.

Solution

Within one month of working together, we had the protocols developed for a trial. The trial had to work for both of us. It was not only about whether we could do the work and how well, but also about how long it would take and what skill level we needed to complete the project.

On November 29, 2010, we developed a proposed list of information and questions for a verification and authorization initial trial. In mid-December 2010, this trial moved into a proposal; and then to “legal” before 2011 began. As with any entity dealing with healthcare, security, HIPAA, and protection of PHI were crucial for OSI. In mid-January 2011, we had a contract and implementation began. We ramped up one (or two) regions at a time, and remained flexible with the protocols, etc.

OSI organized a team specifically for this client and assigned them a project manager. Since turnaround time was crucial, we set up a quality assurance schedule. All of the data the client collected was transferred to OSI through our secure web-based portal. We then developed a list of the information that would be needed for the verification and authorization initial trial.

    • We identified the information necessary before we began each particular clinic/provider such as physician Tax ID, Group and individual insurance provider numbers, network status, and name and billing address of practice
    • To make calls, we requested the client for a copy of insurance card front and back, patient contact information, SSN, and patient employer information
    • When we called, we checked many details: effective date of coverage, medical benefits, availability of secondary coverage, patient responsibility for radiation treatment, relevant medical codes, deductibles and co-pays and where applicable, and patient referral information

We developed a list of questions to elicit this information. As OSI touts flexibility, the number of questions was increased from 25 to 45 as of April 19th. More regions were also added.

All results were subject to stringent quality assurance before they were delivered to the client.

Result

We are averaging about 1500 verifications and authorizations (combined) per month. The company is still “centralized”; but does not have to worry about hiring and firing and training (and retraining) staff. Given the diversification in treatments and location, this is a very good solution as well as economical.

Pre-registration and financial verification now take place much before the patient arrives for a procedure. Last-minute cancellations are avoided and this has made patients happy. Administrative denials have decreased and upfront collections are looking up.

The implementation was not especially “easy”; and both parties continue to need to communicate and stay flexible. Our support person meets with them weekly; and the appropriate production personnel from the people actually doing the calling and the billing people who have to work with the information. It works for both of us… a win-win situation! The success of this project has now spawned into a new project.