INTRODUCTION
Patient screening is a vital step that is critical to every type of practice. Providers should establish a process to adequately screen all types of patients. There are several steps that need to be incorporated into the patient screening process. Some things to consider when initiating or updating existing office practices:
* Complete patient profile for the office files (name, address, insurance, etc.).
* Determination of primary insurance benefits.
* Office staff awareness of those insurance plans that the office “does not have provider/network participation.”
* Identify if the patient has a supplemental insurance plan.
* Identify any instances where the patient has an extenuating circumstance that could cause a change in the insurance currently on file (accident/injury)
* Eligibility information, deductible and coverage limitations.
* Special billing requirements based on where the patient resides (consolidated billing).
Front office staff plays a key role in the success of claims being filed correctly and timely, based on a few minutes spent up-front with the patient or the patient’s responsible party. These tasks that are handled by the front office personnel or person who receives initial patient information become vital to the efficiency and financial welfare of the health care organization to which they belong.
One of the first steps to consider during patient registration is to obtain important patient profile information for the office.
OBTAINING ESSENTIAL PATIENT INFORMATION
Office staff should obtain complete patient information when registering new patients. Usually this is accomplished by the patient completing a medical information/history and insurance information form.
Pay close attention to:
* Obtaining the patient’s full name directly from the card (use of nicknames on Medicare claims will cause unprocessable claim rejections).
* Patient address and phone number.
* Obtaining the name and identification number of other insurance (Medicare or other type of insurance plan involved).
* Date of birth.
* Emergency information.
* Patient’s signature.
o Item 12 of the CMS-1500 claim form or the electronic equivalent (Patient Signature Code – Loop 2300/CLM10 and Release of Information Code – Loop 2300/CLM09) must be signed if the patient authorizes the release of medical information to Medicare and payment of Medicare benefits to the provider. Loop 2300/CLM08 Condition or Response Code – “Y” or “N” to indicate assignment of benefits as “yes” or “no.”
o Item 13 of the CMS-1500 claim form or the electronic equivalent (Patient Signature Code – Loop 2300/Q104 and Benefits Assignment Certification Indicator – Loop 2320/Q103) must be signed by the patient if there is a Medigap insurance plan and the patient authorizes payment of benefits to the provider. Release of Information Code – Loop 2320/Q106 – “Y” indicates the provider has a signed statement.
*Previous medical information (if applicable).
It is also important to periodically review the existing patient’s profile to ensure that the information on file is still current. Patients may have changes to address or insurance information and inadvertently fail to notify office staff of those important changes.
Another important step is to determine the patient’s insurance information, which will be based on the information received on the medical information/history.
