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D E C E M B E R 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
Eligibility verification
Not verifying a patient's insurance coverage — third on our list
of common revenue problems — can make or mar your chances of
getting paid.
Many of our respondents said that front desk staff are having trou-
ble verifying all of the details of patients' insurance before scheduling
their appointments. They're too busy handling appointment phone
calls, collecting co-pays, printing receipts and scanning insurance
cards. It's easy for things to slip between the cracks.
Make sure that if your front-desk staffers are the ones verifying
patients' insurance, you offer training and hire only those with
experience in this area. In addition to training, make sure that you
regularly hold meetings with your front desk to reinforce these
skills as well as identify any issues. Encourage staffers to share
what is working well, or if they're running into recurrent problems.
For example, if your front desk is still having problems with insur-
ance verification, consider hiring someone (either outside of your
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as an inpatient, so long as they document supporting factors, including things like
severity of symptoms or risk of adverse events. CMS says that this designation should
not be used for "minor" surgical procedures or for a period of time that "does not span
at least overnight." For stays longer than 2 midnights, the policy is unchanged.
"We are pleased to see that the agency finalized its changes to the two-midnight
policy," says the American Hospital Association Executive Vice President of
Government Relations and Public Policy, Thomas Nickels. "Hospitals appreciate the cer-
tainty that stays of at least 2 midnights are inpatient, with stays of less than 2 mid-
nights also considered inpatient based on physician judgment."
For a closer look at CMS's updated Payment Systems, visit osmag.net/SevJ3G.
— Kendal Gapinski
