Ask Caryl: Responding to Denials Due to Inaccurate Patient Information

Q: Our ASC seems to be receiving a lot of denials due to inaccurate patient information. Do you have any suggestions on how to remedy this?

Caryl Serbin: Redundancy, redundancy, redundancy! We have found that the following duplication of effort has decreased the number of claims denied for inaccurate patient information.

1. The scheduler should request information from the provider's office (including proper spelling of patient's name). A copy of the patient's insurance card is important in verifying name spelling and insurance information. Accurate entry of this information by the scheduler is the first step.

2. The insurance verifier should verify accuracy of patient's name and numbers with the patient's insurance carrier and make any necessary corrections in their ASC's software program.

3. The patient financial counselor should contact the patient and review all demographic and insurance information and make any necessary corrections at that time.

4. The final threshold for determining accuracy of patient information is at registration on the day of the procedure. The registration clerk/receptionist should provide a written copy of the demographic and insurance information to the patient to review and make changes or additions as directed by the patient.

If all of these steps are followed properly and consistently and the billing clerk checks the claim prior to submission, there is very little chance of claims being denied for inaccurate demographic or insurance information.

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