Posted in Insurance, Training, Updates

Importance of a trained Front Office Staff-avoid unnecessary claim denials & negative reviews.

It is extremely important to properly train your FRONT DESK STAFF on verifying eligibility and conducting benefits investigation for patients.

Increasing the “clean claim” submission reduces your rejection and denial numbers= increase your revenue for the practice!

The other important aspect of training the FRONT DESK STAFF is customer service. Yes, a lot of times patients give the negative reviews based on how they were treated by the FRONT DESK STAFF.

Negative reviews potentially leads to less patients for your practice.

If you would like to find out more about training your FRONT STAFF on either checking patients eligibility, customer services skills, or how to verify properly benefits for your patients, please feel free to book 1-Hour Consulting/Training Session . If you would like to find out more information about my training/consulting services, please feel free to reach out to me via email: (Subject Consulting Questions).

Posted in Insurance

Does your office accept BCBS exchange patients?

When the new healthcare reform took place so did the increase in more plans and networks that the payers, like BCBS started to offer to the members. Great! More people are covered and providers are able to see more patients.

However, the problem that the providers are running in is the fact that these plans have their own network. One of these networks is Pathway x Enhanced, offered by BCBS to the members that buy the insurance on exchange website.

Why is this a problem for the providers? Simple, Pathway X Enhanced network is exclusive to only certain Paycard%20300%20200providers that were selected for that network by the BCBS its self. But I am INN with my Local BCBS, can I join the Pathway X Enhanced network too? Unfortunately the answer to that question is NO. Why? Simply put there is a certain criteria that provider needs to meet in order to be in the Pathway X Enhanced network. You could also request the very complicated explanation from BCBS but if you have not received it in the early 2014. LOL

To avoid rejected/denied claims: train your front staff to recognize which patients have this particular coverage and double check the benefits for incoming patients BEFORE they come to the office-making sure that the incoming new patients have OON benefits and you are not incurring charges that you will have a hard time collecting.


Posted in Insurance

Employee Benefit Cards -copay per doctor visit

Recently, I had a patient that contacted me, to inform me that her Employee Benefit Card was frozen since June. She was so distraught that she was not able to go to the doctor appointments because she was told we overcharged her for a visit.

What?! One thing that I value the most is honesty. “Fraud”- this word that does not sit well with me. I cannot admit or deny that I have seen any medical billing fraud, but it is something that I do not kid about!

Of course, I calmed her down and explained her that there is a perfectly good explanation why we charged her that specific amount for the visit instead of her usual copay. I assured her that I will get to the bottom of this and find out what is going on, and would contact her once I finish my research.

Anyway, after doing some research, I found out that we charged her for 2 DOS’s (dates of service), since she did not pay for her last visit. She used her card on that specific dos to pay for two.


However, what she nor I were aware of is that she cannot charge more than her copay per each visit.

Luckily, I was able to help this patient by sending an explanation along with the EOB, from her insurance, to the Employee Benefit Card Services. She was able to lift her suspension from the card and use it again.

The moral of this story: as a rule of thumb, use your Benny Card to pay only your copay and no more than that amount. Otherwise, you will be in the same situation as this patient and would have to go through the same ordeal.

As for Provider office front staff: make sure to charge only the copay for the given visit. Hint: if you have more than 2 people in the front desk it is extremely helpful to make a list of the patients that do have the Benny card, this way everybody in the office is on the same page!