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 Blizzard Prep ChecklistHave you read our article, “End of Year: Preparing for the Blizzard” yet? It contains in depth information on why, how and when to start preparing for “The Blizzard”. Utilizing this checklist in addition to the article can assist you in ensuring that no patient or medication falls through the cracks this year!OCTOBER□ Ask patients at every appointment about their insurance coverage for 2021 such as:Do they know if their coverage will be changing?Do they think it might possibly change (has received info from their employer but hasn’t read it yet, etc)?Has their employer or insurance company sent any new information to them?Has COVID affected their employment status?Did they change their Medicare plan during Open Enrollment?□ Put up signs reminding patients to notify staff if they receive any communication from their employer or insurance provider including:New documents EmailsNotifications on apps Notifications from patient portalNotifications from text reminder services□ Change appointment reminders and voicemail, patient portal or text messages to include information regarding insurance updates.□ Develop policies and procedures with a January 1st effective date regarding insurance eligibility verification and prior authorization prior to all appointments to include:All appointment reminder communications will include information regarding insurance changes.Eligibility checked two days prior to appointment/injection/infusion.Injected or infused medications will not be administered until insurance has been verified and prior authorization has been obtained.Non-scheduled patients (walk-ins) will be asked to wait briefly until coverage can be verified. Plans requiring any form of prior authorization or pre-service review will be asked to reschedule.If a patient’s insurance has changed but the provider was not notified prior to the scheduled administration date, a delay in therapy may occur in order to financially protect both the patient and the provider.□ Discuss/review new policies and procedures with practice or organization decision makers and obtain approval, if necessary, prior to informing patients of changes.□ If the patient’s insurance has changed in October or will be changing January 1st and they have received the new insurance information or card:Enter new information into your EHR Review and notate effective/coverage start dateSubmit updated information to third party manufacturer programs for a new benefit investigationNOVEMBER□ Open enrollment will be in full swing for employers, the Marketplace (ACA, or Obamacare), and Medicare! Continue asking patients at every appointment the same questions regarding insurance status listed above. Enter updated information into your EHR if available.□ If approval obtained, review new policies and procedures regarding eligibility verification and prior authorizations with practice or organization patient access employees.□ Begin notifying patients at every visit of any new office policies and their effective dates. □ Complete reverification paperwork from third party manufacturer copay or patient assistance programs. Double check all requirements and dates from the manufacturer for the most accurate and beneficial information. □ Verify patient’s copay, grant or other patient assistance programs such as free drug. Contact patient if they are required to reapply or submit documentation to re enroll. Save time from making multiple phone calls and sitting on hold. Make a list of all patients enrolled in each program and make only one call per manufacturer to verify multiple patients. DECEMBER□ Open enrollment will close during this month, however, continue to ask patients at every visit the same questions regarding insurance status.□ Ensure your signs reminding patients to notify staff regarding insurance changes are still visible.□ Continue to remind patients of any new office policy changes and their effective date.□ If not already submitted, complete reverification paperwork from third party manufacturer programs and submit any new insurance information for a new benefit investigation.□ If not already completed, verify and re enroll, if necessary, any outstanding patients in their copay, grant or other patient assistance program.IMPORTANT:Patients requiring an infusion or injection that do not notify staff of their new insurance plan until AFTER receiving their medication, please IMMEDIATELY request or complete the required authorization. Although this may not guarantee payment of the claim, an authorization obtained on the date of service is more likely to result in payment than obtaining an authorization the next day. Some plans may even provide you with a retro-authorization. Requesting authorizations prior to claim adjudication will prevent delays in reimbursement.Stay tuned! A checklist covering the first three months of the new year will be released next! ................
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