Welcoming in the New Year

Tips to Have a Successful and (Mostly) Stress-Free Reverification Season

By Lacey Varnon, ADN, PACS, BCPA
Founder, National Society of Biologic Coordinators

This is the third installment in Lacey’s series on how to successfully navigate “The Blizzard” for reimbursement professionals.  If you missed Parts 1 and 2, check them out here.

We could choose to go into this season completely stressed out, knowing that:

    • Patients may not update their insurance information until the day of their appointment
    • Office staff may continue to administer the drug even if benefits have not been verified
    • A sudden, actual blizzard may in fact freeze part of the country causing shipping delays. (Texas showed us all just how possible that really is)!

Or, we can approach this new year with the understanding that yes, all of these are very real possibilities, but that’s okay because you’re prepared. 

Here are some tips to make sure you can go into 2023 feeling ready.

  1. Patients should be scheduled accordingly based on insurance verification and benefit coverage status. Commercial patients should not be scheduled the first two weeks into the new year. This timing gives staff members time to get information updated and the schedule adjusted accordingly. Medicare with Supplement patients can be scheduled in the interim so as to not delay any further treatment. Be sure this group of patients understands that their deductibles have started over. It can be confusing when they are not used to having any out of pocket costs associated with their treatment.

  2. Prepare for shipping delays. Be proactive; order prior to the holiday based on your current inventory. When possible, pre-order any specialty pharmacy medications to be shipped accordingly.

  3. Make sure the office(s) has plenty of samples on hand; this will help cover those who are still awaiting verification.

  4. Verify eligibility two to three days prior to injection.

  5. When a patient arrives for their first appointment, verify that all demographic information is up to date: including name, insurance, address, and telephone number. This may seem like a very simple task but is often overlooked. “Nothing has changed” is usually not the correct answer. Patients may not realize that their member ID has changed on their new insurance card, and this oversight could potentially cost thousands of dollars.

  6. Scan copies of all provided cards into the EMR system.

  7. For all clinical staff:
    • Any changes in the patient’s information not reflected in the system should immediately be communicated with the access team and administration delayed. The team can help advise if samples should be provided to the patient during this time.
    • Double check that the active insurance is the same as the one listed on prior authorization before injection is administered. If not, provide samples and notify the access team.
    • Be sure to update the prescription on file. While most offices now utilize EMR systems, these prescriptions still need to be kept up to date yearly.
  1. Verify the patient’s copay/financial assistance is active. Remember: if a patient’s insurance changes, copay assistance will need to be updated per terms and conditions.

  2. Listen and communicate with your patients. It is important to remember that while we do this everyday, medication access is still a very confusing concept for many. A patient can easily get frustrated when they do not understand why they suddenly have a copay when they have not been charged one in the last six months, or why they now have to use a specialty pharmacy to get their medication. By being an active listener, you can help alleviate some of their stresses associated with the new year.

Whew, we made it!  Here’s to another great year!

What tools do you use to survive the Blizzard? Send your favorite tips to info@NBCS.health and partners@policyreporter.com to help others that are prepping for the storm. 

If you’re a reimbursement professional, go here to join our Policy Reporter Partners community!  You can earn honoraria for sharing your knowledge, and learn best practices from your peers to help improve patient access and affordability.