Medical Review Policy Matters Make no mistake, the Medical Review Policy (MRP) does matter, and it plays a key role in determining the care that is reimbursable by a payer. The MRP is an administrative and educational tool designed to help providers, physicians, and suppliers submit correct claims for payment. Medical Review Policies outline how…
Collecting Other Detail Coverage Documents In addition to Insurance Verification, it is advisable to collect both the Summary of Benefits and Coverage (SBC) and the Summary Plan Description (SPD) for each patient and store these documents where they are easily accessible. This is just another good practice will that help both you and your patients…
Don’t Forget to Verify Insurance Insurance Verification is a simple step that provides a clear picture of who is responsible for what portion of patients’ charges. Collect the patients’ insurance information from the first phone call so that by their first visit, insurance coverage is understood, and patient responsibility can be calculated based on the…
Why Insurance Verification This quick tutorial explains why insurance verification is an important piece of the financial report of findings (FROF) with the patient. It contains the top tips to make the verification process simple and effective by reviewing the variety of tools available in the KMC University Library. This image provides a sampling of…
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Download Reference Documents The VA has a prolific number of resources available for providers that include webinars, booklets, and online training. We have included a few that can serve as a nice introduction to some of the basics, including terminology and acronyms. The VA is constantly updating their processes; therefore, we recommend that the clinic…
Accessing care from a provider that is not part of the VA healthcare system is considered Community Care. Community Care provides care to Veterans through a community of providers enrolled with select VA programs which are often administered by outside contractors. This care is based on certain conditions, and the patient must meet specific eligibility…