We all know that HMO plans won’t pay for medical care without a referral, but you’d be surprised how often we get denials from insurance companies because the office saw the patient for medical care and no one got a referral. How can you avoid this? Always check the patient’s card! If it says “HMO” or has a primary care physician (PCP) listed, then the plan requires a referral for medical eye care.  Many of your insurance contracts put the burden for obtaining a referral on the provider, and the EOB shows the denial as a contractual write off. Even if your contract doesn’t stipulate and it’s your office’s policy that patients are responsible for getting all referrals, a courtesy reminder to patients can go a long way in gaining goodwill and saving the patient from a large bill they didn’t expect.

In a busy office, it’s inevitable that data entry mistakes are going to happen. Typos are going to happen. But every time a patient’s information gets entered incorrectly, it means the claim will reject or deny, and someone is going to have to do additional work to find the mistake. How do you keep this from happening? A few simple processes can help eliminate the majority of these errors!

First, at check-in always double check basic demographic information: Is the name spelled correctly? Is the address right? Do you have the correct date of birth? Next, ask for a copy of patients’ insurance cards, even if they say their insurance hasn’t changed, and always check that policy ID numbers are entered correctly into your system with alpha characters included but no spaces or dashes. Does the name match the card; is the spelling right? Is the relationship between the subscriber and patient correct? Always get both the patient’s medical and routine vision insurance information since you don’t know where the claim will be filed. Finally, scan the card into your system for future reference should the need arise.