Recipe for Yearly Insurance Updates and Healthcare Changes

This time of the year is all about traditions. Traditions of setting up a tree the day after Thanksgiving; working with a charitable organization; or holiday baking using recipe cards passed down through the family. As children, we grow up with traditions around the holidays. They gave us something to look forward to and be excited about. Now as adults, we pass those traditions on to our children to witness that same excitement. But what traditions do you have for your office and staff each year? Just as you prepare for the holidays with that favorite cookie recipe, your office should have a recipe for keeping up with healthcare changes every year.

Step 1: Gather the Ingredients

Query your office’s preferred insurance carriers.  You will have to know which carriers update their policies on the first of the year (BCBS, FEP) and which update during the year (Johns Hopkins, Tricare). This information is submitted to providers via the insurance carrier’s websites or through mailed/emailed newsletters. Most of the major carriers will submit a newsletter via email on the first of each month (UHC, Aetna, Cigna). Typically this newsletter stands as the carriers’ notice of changes to guidelines and authorizations, updates to procedure codes and general changes with the insurance plans that may affect your patients and the type of care you provide. Take a few minutes each month to review these newsletters to make sure your office is prepared. At the beginning of each year, review the insurance carriers’ provider manual/handbook for changes.

Step 2: Review the Directions

This time of the year is when the majority of changes will affect your daily office routine. Most insurance carriers apply new deductibles, copayments, and benefits beginning in January. Are you a specialist office? Has there been an increase in the copayment a patient must submit for services?

Step 3: Mix Accordingly

Review the insurance carriers for your office. Have most of the carriers made adjustments to codes or just a few? Has one change affected everyone? Do you need to keep old codes in your system for some carriers or possibly adjust that insurance carrier’s file to automatically convert a new code to an old code until the carrier’s files are updated?

Step 4: Prepare and Distribute

As with most cookies, delivery is the most important step! You want to make sure you have enough for everyone. Updating the front office staff of any changes within your preferred carriers is one of the most important steps. Misinformation halts income from coming in to an office. To submit a statement to a group of patients with a particular insurance plan for a remaining $5 balance due can be costly. Inform the providers of coding changes to avoid costly mistakes for charges entered in error. Inform the billing/coding staff of code changes by updating the fee slip/encounter form annually to reflect CPT updates. Distribute copies of new insurance cards to front office staff if HMO policies have been changed. A missed referral can be costly! Finally, make sure all patients are presenting insurance cards for the first few months – whether they were affected by changes or not. Some carriers submit new cards to patients every year. These patients may not realize a group number or prefix changed this year.

Step 5: Store Properly

Storing the policy and manual changes is also very important. Keep these changes on file either on a shared computer file or printed out in a binder to reference throughout the year. There may be instances where this information may have to be referenced at a later date.  If you are appealing a charge, make sure the insurance carrier had the change in effect on that date. For example, Johns Hopkins plans did not update CPT code 20602 for almost 6 months. Having to submit corrected charges with the old codes in order to be paid can be a tedious process. However, keeping the documentation to prove the office was using the correct codes for the year while waiting for the insurance system to update is well worth the effort.

Just as putting a lot of time and effort into your traditions each year is rewarding by seeing the joy exuded by both the giver and receiver, seeing the benefits of updating your insurance carriers’ information is rewarding for your staff, your providers, and your office income.