All medical treatment decisions ultimately belong to your patient. Industry trends indicate that both payers and employers are shifting more of the responsibilities and costs of health care treatment onto patients as well. This shift can create confusion for patients and physicians alike, and lead to difficulties in the payment process. One important strategy for reducing uncertainty in this environment is the establishment of an aggressive program to ensure that each patient’s health insurance eligibility and benefit levels are verified before the patient arrives at the office. This will ensure that both the practice and the patient understand whether there is insurance available, what will be covered by the health insurer and what will remain patient financial responsibility.Recent improvements in the electronic eligibility transaction have made this process much less costly and burdensome. Read more about the electronic eligibility transaction. Physicians and office staff are also encouraged to involve and educate their patients more closely in matters of health insurance coverage and payment responsibilities. Your practice should also consider proactively establishing or revising its payment and collection policies in response to this changing dynamic. "Prepare that claim," and its companion resources "Follow that claim" and "Appeal that claim," were developed to help physicians and their practice staff to review the efficiency of their current internal claims management process. These resources contain sample forms and policies that can be adapted to fit the specific needs of a physician practice, including sample employer/insurance verification information sheets and sample patient/insurance coverage verification forms.
The AMA Practice Management Center and the Kentucky Medical Association have created resources to help you educate patients.
- The document "Helping your patients understand their billing and payment responsibilities" provides physicians and practices with a guideline to helping patients navigate the complex terrain of medical service delivery and payment.
- The flyer "Understanding your health insurance policy and payment practices." may be distributed, or otherwise made available, to patients in order to provide them with an overview of their responsibilities and to address frequently asked questions.
Download this convenient Patient Financial Review Form to easily keep track of payment problems.
Health Insurance Portability and Accountability Act (HIPAA) compliance
Another critical step in the registration process is confirming your privacy and security policies with your patients, and soliciting their preferences with respect to how they are contacted by your practice. Read more about HIPAA requirements.
Get the latest tools, updates on payer issues and invitations to free educational webinars
Sign up for the AMA’s free Practice Management Alerts to receive timely updates on new practice management resources and tools to help you implement claims processing efficiencies and other practice improvements. You’ll also receive alerts about unfair payer practices and ways to address them.
"Heal the Claims Process"™ campaign toolkits and webinars
Access toolkits to help you effectively use key HIPAA electronic health care transactions in your practice, including eligibility, claim status, electronic funds transfer and prior authorization. Don't wait—start experiencing the savings!
Selecting a Practice Management System toolkit
Learn how to select a practice management system that will reduce your time spent on manual administrative tasks that occur throughout the claims revenue cycle and replace them with automated solutions.