If you have been with us for very long at all, you will have heard of the "Info needed" list. This is something we tackle very diligently.
If a claim lands on this dreaded list, there is a good reason. We do not have one or more of the following:
Patient Demographics - If a patient is new to you, we must have their pertinent information. If they are an existing patient and any of their information has changed, we must be alerted. (Address, new insurance, etc.)
Correct Insurance - If we are asking you for this, it means we tried the insurance we have on file and there is a problem with it. (New id number or insurance terminated, etc.)
Pre-Authorization, Pre-Certification, and Referral - This one is huge. There are certain insurance companies that require you to have a pre-authorization, referral or to pre-certify a procedure, visit, or anything done to their member. Please make a list of these insurance companies and get in the habit of calling them prior to seeing your patient. I would call every time if you do not know. These denials happen daily and then we have to put the claim on hold and ask your office to retroactively get a pre-auth, pre-cert or referral. It is much easier if you obtain this up front. It saves us all a big headache.
DLS and PCP - This is a big culprit on the info needed list. Any Medicare or Medicare Replacement plan requires us to include the date the patient last saw their Primary Care Physician and their PCP full name and NPI number. Get in the habit of asking every patient this question and noting it.
Nursing Home Face Sheets - are some of the worst sets of information we get. It comes to us with old Medicare id numbers, hard to read copies and outdated information. As far as obtaining the new Medicare id number: Some of the time we can cross reference on a website we use and get the new id number, if we have the patient's social security number, correct name and date of birth. We do all we can, but sometimes we are not able to put all the puzzle pieces together and we have to ask for help. Especially if "Bunny" Smith is the name on the face sheet and her legal name is Elizabeth! Yes, we get nicknames all the time. Fun in life, but not so much in the billing game! (Also, 123456789D is not a good indication of the patient's social security number. That is their husband's social security number, we are not able to use that to find their new id number. (The D indicates deceased husband.) We do pick up the phone and call Nursing Homes sometimes. Some are helpful and some are not.
Please help us by keeping up on these "info needed" requests. We want to get these clams off of hold and out the door to get you paid. Thank you for all you do. Most of you are amazing responding to anything we need, and we appreciate that!