Fatal Eligibility Errors

AccuReg continues to make excellent strides in the eligibility verification arena by alerting registrars to fatal denial errors due to Medicare and Commercial insurance coordination of benefits, Medicare HMOs and Medicaid limitations.  Every eligibility vendor brings back a 271 transaction that defines patient benefits and restrictions.  One of the primary differentiators with AccuReg is our ability to report back to the patient access staff the priceless data elements that will secure a clean claim directly into their work queue.  AccuReg has made a strong commitment to hire skilled and experienced patient access staff to constantly review the 271 for client opportunities.  Identifying a secondary payer with name of the insurance company, the policy number and address for billing, puts the hospital in a place where they can bill the claim out correctly before bill drop.  More and more state Medicaid’s are developing “plans within plans” where limitations and restrictions are common for pregnancy and post-partum benefits, pre-assigned primary care providers and Medicaid HMOs.  The ability to know this at the time of registration, with an alert to the registrars work queue is of huge value to the revenue cycle!

– Penny Nydegger

AccuReg, Director of Implementation (and 20+ year veteran of patient access)