Checking Outpatient Eligibility
Given the high volume of patients for this 900-bed hospital, The Methodist Hospital didn’t have the staff available to manually verify eligibility on all Medicare outpatient accounts. Patients registered with Medicare for outpatient day surgery or outpatient diagnostic testing, were not included in the regular verification workload.
When the hospital began to see more patients on Medicare replacement plans, it also began to receive more denials due to an incorrect or invalid Medicare number, or the type of Medicare – replacement or traditional. By using Boston WorkStation The Methodist could conduct Medicare outpatient verification without burdening current staff or adding staff.
- Boston WorkStation downloads a text file of all unverified insurance for a rolling 10-day period and converts the text file to an Excel spreadsheet, producing data for the main hospital.
- It deletes all commercial unverified insurances so that only Medicare unverified outpatient accounts are shown.
- It then picks up the modified spreadsheet and compares each patient on the list against the hospital’s McKesson Health Quest system.
- The patient account number is automatically entered into McKesson, and the hospital’s real-time eligibility tool, Relay Health, is triggered to interface with Medicare and report back the status of the eligibility check.
- If the account is active and valid, Boston WorkStation marks the account done and enters the verification result into the patient’s record. If there is an error such as an invalid number, date of birth mismatch, or other insurance primary, it flags the issue and creates a report showing all the patient accounts it looked up and their status.
- The staff follows up on only those accounts which need attention. Accounts that are clear are put through for billing without delay.
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