Ambulatory services are critical healthcare solutions that transfer patients to and from facilities providing continual care in the intermediatory transit. Typically a ambulance contains a stretcher, defibrillator, spine support boards, oxygen, oxygen masks, cervical collars, splints, bandages, a range of drugs, medication bags, suction units, intravenous fluids and several other equipment’s/ drugs/ that help in life-saving/ stabilizing of the patient until reaching a healthcare facility.
When a patient is transported in an ambulance, they may not be in a condition to provide demographic details/ insurance demographic details to the ambulance crew for documentation purposes to create the medical records. The collection of patient/ insurance demographic information is critical for the creation of the claim. There are a number of instances which can influence the missing of critical data such as
- Missing/ incomplete insurance demographic information
- Un-awareness of the insurance details
- Failure to provide insurance demographic information due to circumstances
- The patient could have not provided the insurance information at the time of service
- The patient could have enrolled themselves as self-pay due to un-awareness of insurance coverage and benefits
The ambulatory crew will be more focused on saving and stabilizing the patient than concentrate on the collection of details from the patient. The crew may just move on to the next ambulatory call once they have handed over the current patient to a facility.
The Insurance Discovery software, a unique creation of healthcare veterans and combining technology helps in the retrieval of insurance demographic data. The tool comprises of 15 algorithms that retrieve the insurance demographic information and has the capabilities of updating the algorithms based on the insurance outcome. The Insurance Discovery tool provides the perfect solution for ambulatory services.
By entering a few patients’ demographic details, the Insurance Discovery tool will be able to retrieve the current active insurance demographic details. The tool’s intelligent programming also provides the COB (Co-Ordination Of Benefits) information if the patient has multiple active insurance coverages. By selecting the correct active insurance coverage, the billing office will be able to file the claim to the correct payor for reimbursement reducing errors arising due to coverage, missing/ incomplete insurance details. The faster reimbursement of claims helps the CBO (Centralized Billing Office) to maintain a reduced AR days (DSO – Daily Sales Outstanding) showcasing a best practise scenario.
Identifying the correct responsible insurance carrier prevents the claim from landing in private pay/ self-pay patient responsibilities. Typically, collection of outstanding from patient responsibility is tedious work when compared to collecting from the insurance payors. Sometimes the patient responsibility may end up in writing off potential reimbursement due to un-identification of the correct payor and no response from the patients.
The Insurance Discovery tool provides the best solution in cases wherein the ambulance crew is unable to gather information other than basic patient details from their identification cards. Even if the details gathered are not sufficient at the time of service, the back office will be able to retrieve patient/ insurance demographic information using the Insurance Discovery tool that provides precise information.
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