The saying “A stitch in time saves nine” definitely holds true with respect to an organizations reimbursement process for complicated home infusion therapies. Your patient intake process plays a critical role in how the services will be reimbursed. From referral to admission, there are critical steps which need to be completed. Having an intake checklist to ensure that all tasks are completed and updated in the system is a must. A good way to make sure you are capturing this information, as well as keeping your customers engaged and knowledgeable regarding what to expect with their therapy, is to conduct a short “Welcome Call”. This process can help augment the patient intake process by verifying that all data and documentation details have been captured correctly.
Typically, an organizations “Welcome Call” process would involve the following main steps:
- Check to ensure accurate patient demographics are captured
- Verify complete insurance information (primary, secondary, etc.)
- Obtain the correct patient address (in particular for commercial claims)
- Verify employer information
- If the therapy is work or injury related, obtain a Workers Compensation claim number and contact information for the claim adjuster handling the case
- Identify the location of IV benefits (i.e. medical supplies, pharmacy, home health, case management, or the proper combination of these)
- Check to ensure that the Advance Beneficiary Notice of Non Coverage (ABN) has been signed and properly executed
- Check to ensure and document prior authorization is in writing (rather than by verbal approval) whenever possible
- Record the date for the next reauthorization
- Verify the required attachments have been collected [e.g. DME Information Form (DIF), Certification of Medical Necessity (CMN), prescriptions, nursing notes, etc.)
- Obtain supporting clinical documentation (i.e. labs, X-rays, etc.)
The Avantha Business Solutions team uses the “Welcome Call” process and approach to help its clients smooth out any issues they may have in patient intake, all in a effort to help its clients dramatically reduce issues with authorizations, reauthorizations, CMN’s, and ABN’s
Please feel free to get in touch with us to learn about our proven approach and methodology.