January is a huge month in which clients’ insurance plans change. Open enrollment season for Medicare Advantage, Medicaid Managed Care, MarketPlace (Exchange) products and many employer sponsored health plans occur during the November- December time frame and is usually effective January 1st. Your client base could have a very high insurance plan turnover. You want to verify your clients’ eligibility before you bill and receive the remits (30 days later) stating the client is no longer covered under this plan.
For those agencies that participate in commercial insurance plans, is your administrative staff verifying existing clients’ benefit plan designs?
Client deductibles have gone through the roof. Gone are the days of small deductibles and co-insurance amounts. Most benefit plans continue to shift both the premium and benefit plan design costs to the member. Unfortunately, most clients are going to shoulder the lion share of costs for services rendered. Your organization will need to develop a proactive financial plan so that your clients will understand exactly what they will owe and hopefully avoid the uncomfortable financial misunderstandings later.
Are Staff reviewing the current clinical authorization date spans to make sure that there will be no denials because the authorization did not extend into the New Year?
Some Managed Care Plans will have their clinical authorizations date span end December 31, 2019. You want to make sure that all clients needing authorization for their services, are reviewed and if needed, modified in covering services into January. Clinical authorizations are generally made up of a number of authorized sessions and a corresponding date span. Most organizations pay attention to the number of visits and not the date span. Staff will need to pay attention to both so that services are not needlessly denied for “no authorization”.