Wrong primary payer? Bad info equals denials

Ask the right questions

Registrars might learn more information after asking patients with inactive coverage, “While reviewing your insurance, we are getting notification that you have another primary payer. Do you have any other insurance?”

If the answer is yes, registrars can ask the patients to contact their current insurance carriers to update their information so the claims will process correctly, says Jennifer White, director of patient access at Cottage Hospital in Woodsville, NH.

“We provide the number to the patient,” says White. “We let them know they will be asked when the other carrier policy was terminated, so they will want to have that information available when they call.”

Inactive benefits might be due to patients changing their Medicare coverage to an HMO. Carole L. Sraver, director of patient access at Washington Adventist Hospital in Takoma Park, MD, says, “They don’t understand that it’s not a secondary insurance. It is a replacement to their Medicare.”

If the proper information is not available prior to the bill being sent out, or if the patient changed to a Medicare HMO product and authorization was needed, the claim will be denied. “In this instance, the patient is not liable, as the hospital failed to follow proper procedure as laid out by the insurance company,” adds Sraver.

Washington Adventist’s registrars have access to Medicare eligibility software that tells them if a patient is straight Medicare or has changed to an HMO. “Initially, we had to teach the patient access staff what the system was telling them,” says Sraver. “Now that the staff is educated, they are better able to assist in educating the patients to understand their insurance coverage.”

Members of the patient access staff at Cottage Hospital see a high volume of Medicare patients, says White. “We work regularly with patients to inform them they need to contact Medicare to resolve any payer order issues, or old liability or workers’ compensation information,” says White.

When registrars receive the information, they ask the patient if his or her services are related to the liability or workers’ compensation information that has returned.

“If it is, we update the account accordingly,” says White. “If the information is old or closed, we ask the patient to contact Medicare and update them with the information. We provide the contact numbers to the patients to help move the process along.”