Schedule Review in Bradenton
Schedule Review & Pre-Appointment Verification Process- Per Location
Ensuring a seamless patient experience and efficient practice operations begins with thorough pre-appointment preparation. This process involves a dedicated team member who reviews the schedule three business days before each patient appointment. By confirming insurance, financial, and documentation readiness, the practice can enhance service quality and minimize disruptions.
Step 1: Eligibility, Coverage & Frequency Verification
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Verify Insurance Eligibility: Confirm that the patient's insurance is active for the scheduled date of service.
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Review Plan Details: Examine any limitations, waiting periods, exclusions, or clauses that might affect coverage.
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Confirm Frequency Limitations: Check for limitations on preventive, restorative, periodontal, major services, etc.
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Identify Concerns: Spot any issues that may impact payment or claim approval early.
Step 2: Outstanding Claim Review
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Examine Claims: Look into outstanding, pending, or denied claims associated with the patient's account.
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Identify Issues: Pay attention to missing information, attachments, denials, pending claims, and Coordination of Benefits (COB) issues.
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Flag Payable Issues: Resolve any payment concerns before the appointment whenever feasible.
Step 3: Documentation & Paperwork Verification
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Verify Required Paperwork: Ensure demographic information, insurance details, and consent and financial policy forms are on file.
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Secure Missing Information: Send secure links to patients for completing any missing forms.
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Request ID and Insurance Card: Ask for a copy of the patient's photo ID if not on file and an updated insurance card annually, unless coverage is inactive or changed.
Step 4: Financial Responsibility Review
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Calculate Patient Portion: Determine the estimated patient responsibility for scheduled services, including deductibles, co-insurance, co-payments, and non-covered services.
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Identify Past-Due Balances: Check for any overdue balances on the patient's account.
Step 5: Patient & Office Communication
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Communicate with Patient: Send a text message three days before the appointment with the following:
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Confirmation of insurance status
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Notification of any amount due at the appointment
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Requests for outstanding documentation, if applicable
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Inform the Office: Provide the office with:
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Eligibility and coverage findings
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Concerns regarding outstanding claims
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Documentation status
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Exact amount to collect from the patient at check-in
Outcome for the Practice
Implementing this comprehensive pre-appointment verification process results in:
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Clear Expectations: Patients are well-informed before their arrival, reducing surprises.
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Improved Collections: Enhanced point-of-service collections due to prior financial clarity.
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Reduced Denials and Delays: Fewer eligibility-related issues lead to smoother claim processing.
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Less Stress for Front-Desk Staff: Minimized last-minute scrambling and stress at check-in.
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Consistent Workflows: Establishes a predictable and compliant process for handling patient appointments.
By adhering to these steps, the practice can ensure a streamlined and efficient approach to patient care, leading to improved satisfaction for both patients and staff.
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