GeBBS Healthcare Blog

Is It Time for a Billing Operations Check-Up? How to Assess the Health of Your Revenue Cycle

Posted on Thu, Apr 04, 2019 @ 07:35 AM

Balancing the competitive landscape that comes with physician practice consolidation combined with population health and the shift to value-based care is a lot to consider for busy hospital physician practices.  Add in the constant changes in regulatory guidelines, enhancing the patient experience and most importantly – a continued focus on quality and safety and most hospital administrators have little resources left to focus on improving the revenue cycle.

However – some may argue the revenue cycle is of equal or greater importance to all of these critical factors. That’s because improving your revenue cycle has a direct impact on patient care. Without a positive bottom line, you won’t have the resources necessary to invest in staff, facilities, technology, equipment and supplies needed to deliver the highest quality care.  

That’s why it’s important to regularly audit the health of your revenue cycle – which starts with a complete review of your billing performance metrics.  Whether you handle your own billing in-house or have an outsourced billing partner – it’s critical to evaluate your performance on a regular basis. 

Billing Operations Check-Up Checklist

Here are some questions to consider when evaluating your billing performance.

Are your self-pay collections practices ineffective? With the increase in high-deductible plans, patient responsibility for charges has increased significantly, but large health systems and physician practice groups have been slow to collect fees from patients. It might be time to evaluate your up-front collections policies - as well as your processes for collecting self-pay fees. Ensuring your statements are easy to understand and the implementation of technology solutions that utilize analytics to determine the best time to contact based on propensity to pay scores can help drive higher patient collections.


How is your denial management handled? Denied claims can quickly increase your A/R cycle and increase your overall cost-to-collect. That’s why your team should have qualified denial management specialists who are familiar with your practice management system and understand how to quickly and correctly analyze account history and appeal denied claims. Analysts who are adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R. Ideally, your billing team should be using a customized tool with fully integrated data analytics that provides real-time trending with the ability to isolate and prevent future denial re-occurrences.


What are your key metrics? The best way to move the needle on improving your revenue cycle is to get familiar with the data – which you’ve most likely already done. From there, work with your executives and financial leadership teams to identify, track and make a plan to optimize the key performance indicators (KPIs) that are most important to your practice or system. Partnering with an organization that can provide in-depth data analytics and customized dashboards is a great way to get started. Some common KPIs to consider are as follows:

  • - What is your percentage of total receivables in the 120+ days category?
    - What is your first pass rate?
    - What is your charge entry accuracy?
    - What percent of open claims have no collection activity?
    - Value of claims that were written off (Charge=Adjustment?
    - How is your payment to charge ratio (or collections per RVU) changing?
    - What is your turn around time for denial resolution?

Once you’ve identified your opportunities for improvement, you need a solid performance improvement plan.  Whether you manage billing in-house or outsource, develop goals and targeted initiatives to drive certain key metrics on a routine basis. Sometimes even small initiatives designed to drive performance in a single area of your billing process can result in a significant, lasting impact on your overall financial performance. 

Not sure where to start? GeBBS Healthcare has decades of expertise helping large, hospital-affiliated practices improve their revenue cycle. We’re glad to offer a no-cost analysis of your accounts receivable (A/R) metrics to help you benchmark your performance against similar systems.

For the no-cost analysis submit a request for consultation (click here)

Tags: Accounts Receivable (A/R), Offshore Medical Billing, outsourced medical billing, RCM Solutions

3 Ways Hospitals Can Improve Their CMS Star Rating (Regardless of its Flaws)

Posted on Fri, Mar 29, 2019 @ 08:14 AM

Lots of questions and headlines began swirling earlier this month after the Centers for Medicare and Medicaid Services (CMS) released its hospital star ratings – a “seemingly” simple system designed to help consumers make informed decisions about hospitals and the care they deliver.  While consumers are used to 5-star ratings for hotels and restaurants, the healthcare industry is clearly far more complex.  As such, a cloud of mystery and skepticism surrounds this incredibly powerful rating system – especially for the thousands of hospitals who participate in Medicare and are therefore automatically subject to stardom whether they like it or not.

Up to 60 quality metrics are combined to create this important rating – although hospitals often don’t know exactly which measures are included or how the measures are weighted – until after the ratings are released. While the star-rating system has been under attack for years by health systems claiming the system is flawed – the information can still help healthcare organizations make critical decisions about where to focus their efforts.

While consumerism has been slower to hit the healthcare market, it’s still having an impact as patients read headlines from hospitals boasting their 5-star ratings and wonder what rating their hospital of choice may have received.  With that said, what are you doing to ensure your hospital comes in with five stars next time around?

Regardless of your star rating or your agreement with the methodology that got you there – there are three things every hospital can do to help ensure the stars are in your favor.

  1. Benchmark Yourself Against Your Peers, Not Your Neighbors. It’s clear that the methodology used to determine CMS star ratings doesn’t favor larger systems with highly-acute, complex patients. That’s why hospitals shouldn’t necessarily compare themselves to their closest hospital competitors, but instead to like hospitals across the country. If you’re a large academic medical center, see how your star rating compares with hospitals that focus on similar service lines (i.e. cancer, cardiovascular care, etc.) and have approximately the same number of beds. Likewise, if you’re a small community hospital focused on elective orthopedic procedures, compare yourself to a similar organization in another market.  In either case, if your peers are performing better than you – dig into the data to see what you can do better.
  2. Chase Those Zeroes. “Safety of Care” was weighted at 22% for this year’s star rating criteria. Regardless of a hospital’s size, specialty or location, those with low hospital-acquired infection, preventable patient harm and readmission rates are going to perform better than those who struggle in these areas. Hospitals that focus on eliminating infections such as c. diff, CAUTIs, CLABSIs, patient falls with harm and readmission rates – will boast great scores on the PSI-90 composite metric – a leading measure used in determining a hospital’s star rating.  More importantly – as a hospital, focusing on eliminating preventable patient harm is the right thing to do no matter how you look at it.
  3. Focus on Patient Communication. Several measures related to how well nurses and physicians communicate with their patients have an impact on the overall patient experience. Hospitals that closely monitor their HCAHPS scores and use data to make improvements – may just see their star ratings improve, too. Whether it’s overall communication about a patient’s condition, procedure or hospital stay – or something more specific such as medications, discharge instructions, or transition of care, focusing on improving patient communication is sure to help your patients have a better experience. With the patient experience weighing in at 22% of this year’s overall star rating – it’s a worthy investment of your time and effort.
If you want to check hospital star ratings, visit Medicare.gov’s Hospital Compare web site.  If you have an opinion you’d like to share with CMS about star ratings – they are seeking public comment until March 29,2019

Tags: RCM Solutions

800 Hospitals Forfeit 1% of Revenue to CMS For Poor Performance

Posted on Fri, Mar 15, 2019 @ 01:00 PM

Last week, CMS reported that 800 hospitals will be required to forfeit 1 percent of their reimbursement for missing the mark on reducing hospital-acquired conditions (HACs).  The race to eliminate preventable patient harm has always been a top hospital goal, but now it’s one tied to their reimbursement through the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program (HACRP). No matter how hard hospitals work to improve their performance, CMS will penalize the lowest performing quartile (25%) of hospitals annually.

At a time when hospitals are fighting harder than ever to maintain profitability, forfeiting millions of dollars in revenue can make all the difference in a hospital’s ability to remain sustainable. We all know running a hospital has become increasingly complex in recent years.  The entire healthcare system is facing pressures to reduce cost, while reimbursement remains on a steady decline. Operating costs have increased as health systems are spending millions annually on relatively new expenses such as EMR technology and physician employment models.  The shift to value-based care is causing uncertainty and requires the development of new strategies and innovative care delivery models – all of which involve intensive time and resources.

Is Outsourcing the Key?

How can hospitals possibly respond to these mounting pressures, while remaining profitable and maintaining their mission?  While it sounds simple and it’s certainly easier said than done – it’s time for hospitals get back to the basics. What does this mean exactly? One would argue that the hospitals who focus on their core mission by placing the majority of their resources on directly serving their patients are the ones that will come out on top when the shift to value-based care becomes a reality.  This means outsourcing other critical functions – when and where it makes sense. 

Specifically, outsourcing highly specialized business and administrative functions such as revenue cycle management (RCM), clinical documentation improvement (CDI), call centers and collections services, as well as other core functions will allow hospitals to reduce overhead costs associated with hiring, training, salaries/benefits and turnover.  While outsourcing has gotten a bad rap in the past – hiring highly specialized experts who focus on narrow niche fields such as these has proven its ROI time and again for health systems, both small and large.  The key is to find the right outsourcing partner and empowering them to do what they do best on your behalf.  What happens next? Hospitals get to focus on what they do best and why they got into healthcare in the first place – delivering exceptional patient care and improving the health of the communities they serve. 

For nearly 15 years, GeBBS Healthcare Solutions has been helping health systems improve financial performance, compliance and patient satisfaction by delivering industry-leading solutions for revenue cycle management (RCM), health information management (HIM) and patient contact services.  They are praised by their customers for establishing a true partnership model and delivering exceptional ROI. To learn more, visit www.gebbs.com

CMS Will Only Adjust Medicaid Rules – Not Drastically Change Them

Posted on Tue, Nov 20, 2018 @ 05:00 AM

After much ballyhoo and for years of promising a major overhaul to the cost-prohibitive Obama-era managed care rules, the CMS has issued a proposed regulation that makes smaller changes – not the drastic “gutting” that had been promised -- to the standards states meet when running their Medicaid plans.

The proposed rule issued Thursday would give states some new flexibility in setting rates for their managed care plans and ensuring insurance companies have adequate provider networks. There still no oversight on how private insurance companies managing these state plans use the money for patient care and the profits they can reap.

The agency estimates that the changes it's proposing would cut states' administrative costs by $27 million, or 120,000 hours less in clerical tasks.

The new proposed rule doesn't affect the key linchpin of the Obama-era rulemaking, which set a federal medical-loss ratio (MLR) of 85%. That means all insurers must spend at least 85% of their Medicaid revenue on medical care and other activities that improve quality.

The Trump-era CMS has said it supports the 85% MLR provision because it believes it will help control spending in the program.

The new rule focuses on states' secondary concerns. For instance, the Obama rulemaking required states to develop and enforce minimum travel time and distance standards for providers. Medicaid directors have complained this policy wouldn't improve network adequacy, noting that there's no guarantee a provider or specialist practices within certain distance of a patient.

The proposed rule would allow states to use quantitative standards to judge plans' networks. That could include data such as how long it takes for a patient to get an appointment or provider-to-patient ratios.

CMS has said they believe that this change would enable states to choose from a variety of quantitative network adequacy standards that meet the needs of their respective Medicaid programs in more meaningful and effective ways.

It seems to me the more things change the more they stay the same.

GeBBS Healthcare Solutions is a leading technology-enabled provider of revenue cycle management (RCM) and Government Payer solutions. GeBBS’ innovative technology, combined with its over 6,000-strong global workforce, helps clients improve financial performance, compliance, and patient satisfaction. Visit our website to see how our services can work for you.

 

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Tags: RCM Solutions, Revenue Cycle Solutions

Billions of Dollars Flow into Private Medicaid Plans with NO Cost Oversight or Efficacy of Treatment Determined

Posted on Wed, Nov 07, 2018 @ 10:52 AM

Cost containment has become a leading factor in the delivery of healthcare. What are some of the issues that are contributing to these burgeoning costs? One of them is Medicaid. We spent over $576 billion on Medicaid programs in 2017, as reported by the Kaiser Family Foundation.

A recent article in Kaiser Health News noted that 75 million low-income Americans rely on private Medicaid managed care programs. These programs have grown rapidly since 2014, boosted by the influx of new beneficiaries under the Affordable Care Act (ACA). Many states eagerly tapped into the services of private insurers as one way to cope with the expansion of Medicaid costs under the ACA, which has added 12 million people to the rolls. Outsourcing these government-payer programs to private insurers has become the preferred method for handling Medicaid in 38 states.

In return for their fixed fees, these private insurers provide treatment within a limited network -- in theory -- allowing for more judicious, less expensive care. States contract with health plans as a way to lock in some predictability in their annual budgets. Participating states in these private programs are funneling nearly $300 billion annually into private Medicaid insurers.

Are these private Medicaid insurance companies -- who are now receiving hundreds of billions in public money — earning their fees?

Hard evidence is lacking that these private contractors improve patient care or save government money. When auditors, lawmakers and regulators examine the records, many conclude that private Medicaid insurers fail to account for the dollars spent, document the care delivered, or provide access to a sufficient number of doctors. Oversight is sorely lacking and lawmakers in a number of states have raised alarms even as they continue to pay billions. Another “fly in the ointment” is that these private plans get to keep what they don’t spend. That means profits can flow from greater efficiency -- or from skimping on care and taking in excess government payments.

What is the solution to cost containment on these government-funded private payer programs?

Independent outsourced auditors who have deep experience in auditing insurance claims and determining the efficacy and quality of medical treatments can be utilized to monitor these privately managed care plans.

These independent outsourced auditors will have the information technology solutions to deliver highly skilled professionals, robust audit processes, proprietary workflow engines, and world-class IT infrastructures.

They can deliver immediately audit workflow and operations management to ensure consistency throughout the managed care plan audit process that will monitor and report the true cost of medical treatments and the quality of care being provided to patients.

Let’s get the “fox out of the henhouse” and move toward a system that will contain costs, and more importantly, improve the patient care being delivered.

GeBBS Healthcare Solutions is a leading technology-enabled provider of revenue cycle management (RCM) and Government Payer solutions. GeBBS’ innovative technology, combined with its over 6,000-strong global workforce, helps clients improve financial performance, compliance, and patient satisfaction. Visit our website to see how our services can work for you.

 

If you liked our blog please like, share, and comment!

 

Tags: RCM Solutions, Revenue Cycle Solutions

Improving Revenue Cycle Management with Point of Service Collections via Estimation and Eligibility Checking

Posted on Tue, Sep 25, 2018 @ 09:00 AM

A significant share of today’s hospital and doctor reimbursements now come from patients rather than commercial payers, yet many providers haven't updated their collection practices. As charge amounts on medical bills continue to rise, healthcare providers are increasingly challenged to collect the high deductible amounts owed them. Patients are also more conscious of how much they spend on healthcare services as medical costs consume an increasingly large portion of their paychecks.

Ten years ago, high deductibles were an innovative way to reduce employer healthcare spending and encourage policyholders to shop and compare costs when choosing healthcare services. Now, the recent popularity of high deductible health plans has caused many patients to experience difficulty paying medical bills, causing a significant consumer medical debt problem downstream.

There is a definite link between high deductibles and bad debt. Medical bills are the highest cause of bankruptcy in America according to multiple studies. The Kaiser Family Foundation and The New York Times found 20 percent of insured patients reported having difficulty paying for their medical care within the past year.

What can be done to ameliorate this financial challenge?

GeBBS Healthcare Solutions provides a suite of self-pay collection solutions that can help healthcare providers cope with this new phenomenon. We start with a remotely-hosted Centralized Eligibility Unit for hospitals, faculty practice plans, PMS/EMR vendors, and billing companies. The solution consists of GeBBS staff, technology, management and expertise that delivers high-quality, cost-effective patient insurance eligibility and related services. We then follow-up with proven self-pay collection solutions.

A 2009 McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses up to $1,000 per year and 90 percent would pay for medical expenses up to $500 per year.

Reasons for a rise in self-pay bad debts are due in part to inefficient and ineffective collection practices followed by billing companies and physician practices. Providing the patient with easy access to patient statements that are easy to understand will help drive higher patient collections.

The GeBBS self-pay collections team uses technology-enabled practices to maximize patient contact using:

  • Automated dialers
  • Digital messaging campaigns
  • Mobile technology to drive text messaging campaigns

 

The GeBBs Self-Pay Collections team leverages analytics to arrive at the best time to contact and propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios

We work with the patients and offer them flexible payment options and easy access to payment and capability for capabilities for web, phone, credit card, and e-check payments.

 

Expert Coding Can Ensure You Are Maximizing Your Revenue Cycle

Posted on Tue, Sep 11, 2018 @ 06:00 AM

Declining reimbursements are one of the biggest challenges healthcare providers face today. Ask any physician or hospital and they will tell you about the daily struggle of getting paid for their services. However, many healthcare providers are leaving a significant amount of money on the table by under coding.

To be correctly reimbursed for their services, providers have to code procedures accurately so insurers will pay them the agreed-upon amount. Over coding and under coding both occur when providers aren’t coding correctly and both can result in serious consequences. While over coding can lead to an audit, under coders risk being charged with Medicare noncompliance.

Studies have found that around one-third of visits were under coded according to accompanying written documentation, and about half were under coded based on documentation of medical decision making. An astounding 80% were under coded based upon the number of problems presented by the patient during the visit.

Evaluation and management services in family medical practices are often under coded compared to the actual services provided. Under coding can occur when doctors don't consider problems mentioned by patients, and when they don't document additional work done with patients.

Under coding may forestall an audit, but it also causes practices to leave thousands of dollars on the table every year.

GeBBS Healthcare Solutions with our 2,000+ coders can assure you do not leave money on the table with one of our FlexSource-final-logo-RGB solutions. Our experienced and certified coding team will provide a customized coding solution to meet your specific needs. You can pick the delivery location that meets your specific scope, preference and budget. Whether you need coders onshore or offshore or in both locations the choice is yours. In addition to that you get access to our technology and best practices as part of the solution.

GeBBS coders use our proprietary iCode_Workflow_Logo coding software, which enables faster and more accurate coding. In addition, coding quality is monitored and improved using our proprietary iCA-logo-300dpi-01 coding audit software.

iCode_Workflow_Logo (iCW) is an intelligent coding workflow software that enhances coder performance and improves the overall coding process. iCW accepts any kind of input source with built-in functionalities of customizing and mapping incoming data fields. It creates and supports business rules based on client requirements and generates output into a customized format compatible with client systems. As a one-stop coding solution, iCW provides a single platform with integrated coding quality assurance built in to the workflow, exception management tools, and a platform that helps communicate a variety of standard and configurable reports at the aggregate and individual levels with providers and other stakeholders.

To ensure you are always coding at the exact appropriate level, GeBBS’ iCA-logo-300dpi-01 provides a comprehensive, customizable medical coding audit SaaS solution. With built-in workflow, interactive audit management dashboard, detailed scorecards, and robust reporting, it optimizes and accelerates the coding audit process. For hospitals and providers, it improves overall coding quality and compliance while providing the ability to access audited and scored records for education, review and process improvements. Based on OIG audit methodology and AHIMA’s best practices standards, it supports accurate and compliant coding for both facility and professional fee records.

Trust GeBBS Healthcare Solutions to ensure you are not leaving any revenue – that you deserve – on the table.

 

Pre-authorization as a Service Requires Both Technology and Human Components

Posted on Tue, Aug 21, 2018 @ 09:00 AM

Most claim denials are due to the lack of verifying benefit information prior to services being provided. Insurance verification process is crucial for all hospital encounters, whether inpatient, outpatient or ambulatory care. It will ensure that the hospital or physician receives payment for services rendered and will help determine the patient’s share of the charges referred to as the patient’s responsibility.

Eligibility verification is the process of checking a patient’s active coverage with the insurance company and verifying the authenticity of his or her claims. In order to avoid claim rejection, the verification process must be done before the patient is admitted into a hospital, sees a physician or gets services by a medical professional.

Coverage and eligibility benefits should be verified for all new patients and hospital admissions. Coverage and benefits will also be verified for any patient who indicates a change to their coverage and for all high dollar procedures. Pre-authorization is required for many non-emergency medical procedures and services.

GeBBS end-to-end, comprehensive revenue cycle management (RCM) solutions provide this pre-authorization as a service using both technology and human elements. With 12+ years of RCM experience, our billing experts are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. We follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of our proven experience and expertise.

Our solution includes:

  • Scheduling, Eligibility Verification, and Pre-Authorization
  • Customer/Patient Contact by knowledgeable healthcare professionals

The solution renders many benefits including:

  • Reduce overhead costs and streamline staff workflow
  • Improve overall yield by reducing denials
  • Improve patient satisfaction scores (no more turning patients away or rescheduling)
  • Improve referring doctor relationships
  • Focus on patients not paperwork

 

Among the major trends affecting healthcare payments are the new high-deductible insurance plans. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressure. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through pre-authorizations of services covered, payment plans, and more. GeBBS patient access management solutions make it easier for patients to stay on top of their new responsibilities, lowers your costs and increases revenue.

 

Transforming the Business of Healthcare

Posted on Fri, Jun 15, 2018 @ 02:09 PM

The overall theme of this year’s HFMA Annual Conference is “Transforming the Business of Healthcare,” and it is right on target. No other industry is experiencing more evolution and transformational change than healthcare. It seems that the only thing we can count on is change -- this is even more true for the business side of healthcare delivery.

Managing change is all about handling the complexity of the process. It is about evaluating, planning and implementing operations, tactics and strategies. It is never a choice between technological or people-oriented solutions, but a combination of both. This is certainly true when it comes to revenue cycle management (RCM).

This period of transformation is precisely the time to engage with a partner who brings a deep understanding of revenue cycle management to the table. GeBBS Healthcare Solutions provides tailored revenue cycle management solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. We deliver solutions specific to the clients’ needs and work with their legacy systems, using their tools. GeBBS builds efficient workflow processes with higher output through the use of hybrid solutions that employ both automated technology and the expertise of qualified people.

Serving thousands of hospitals and healthcare organizations nationwide, GeBBS provides end-to-end, comprehensive revenue cycle management solutions from payer credentialing to complete billing and collections services. With many years of RCM experience, our billing experts are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. We follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of our proven experience and expertise. Our comprehensive range of revenue cycle management solutions, include:

  • Accounts Receivable (A/R) Management -- Lack of skilled resources can lead to a backlog of claims that need to be processed. It is critical to success to have access to a large pool of qualified resources that can work with your organization and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.
  • Credit balance resolution -- HFMA calls credit balances the “stealth aircraft of hospital patient accounting.” GeBBS maintains a team specialized in credit balances resolution. Our team is comprised of highly-qualified individuals with hospital accounting backgrounds and strong analytical skills.
  • Denial management – The key to success in denial management is having access to a large pool of qualified denial management resources that can work with healthcare organizations and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover lost revenue.
  • Extended business office-- GeBBS offers comprehensive extended business office (data entry) solutions that take the worry out of the RCM process by improving your efficiency and collections while reducing costs.

Let us help you transform your business side of healthcare delivery. With GeBBS as your partner, there is no reason to fear change – we can help you embrace it and make change work for you!

The Importance of Eligibility Verification and Pre-authorization

Posted on Thu, May 31, 2018 @ 10:30 AM

In medical billing terminology, eligibility verification, pre-authorization, prior authorization and pre-certification are terms that may be used interchangeably to mean that for certain situations and procedures, providers have to contact insurers in advance and obtain a certification number in order to be reimbursed properly (or at all) for services. Insurance verification and insurance authorization services play a vital role in revenue cycle management. In fact, most claim denials happen when a patient is ineligible for services billed by the provider.

Depending on what the patient's coverage documents and the provider's contract with the insurer specifies, neglecting to obtain pre-authorization can result in reduced reimbursements or lower benefits for the patient. If a provider neglects to obtain pre-authorization and payment is denied by the insurer, it may come down to absorbing the cost of the treatment or trying to collect it directly from the patient.

GeBBS Healthcare Solutions, with our Eligibility Verification and Pre-Authorization services, specializes in next generation revenue cycle management to help increase cash flow and speed medical billing processes.

With today’s high-deductible insurance policies, insurance and eligibility verification are absolutely critical. Identifying patient responsibility upfront, prior to the visit, is critical to managing the receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment.

A McKinsey Quarterly survey of retail healthcare consumers showed that 52 percent of consumers would pay from $200 to $500 or more by credit or debit card when they visit a physician, if an estimate was provided at the point of care.

To avoid these problems, GeBBS provides a remotely-hosted Centralized Eligibility Unit for hospitals, faculty practice plans, PMS/EMR vendors, and billing companies. The solution consists of GeBBS staff, technology, management and expertise that delivers high-quality, cost-effective patient insurance eligibility and related services.

GeBBS Eligibility Verification/Pre-authorization Services can:

  • Improve A/R cycles (reduce A/R days)
  • Increase cash collections by reducing write-offs and denials
  • Receive schedules from the hospital via EDI, email or fax
  • Verify coverage on all primary and secondary (if applicable) payers by utilizing sites like WebMD, payer web sites, interactive voice response systems, and phone calls to payers
  • Contact patients to get updated insurance information
  • Provide the clients with the results, which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay information
  • Obtain pre-authorization number
  • Obtain referral from PCP
  • Enter/update patient demographics
  • Remind patient of POS collection requirements
  • Inform client if there is an issue with coverage or authorization
  • Process Medicaid enrollment