Preparing for Open Enrollment: Tips for Healthcare Practices

So many coverage updates and no time to get it all done? You’re not alone. Several small and multispecialty clinics struggle to manage data changes as people rush to change their health coverage during the open enrollment season.    

Remember that the enrollment period might also result in a surge in patient calls. These calls could involve inquiries about whether your doctors are in-network, requests for documents to verify eligibility for specific plans, or questions about which plans would most suit their particular situation (such as having a new baby or starting a new job). 

Receive practical guidance on efficiently managing patient inquiries, optimizing outsourced billing teams, and preparing your staff to ensure that coverage details are up to date and claim denials stay at zero.

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Preparing Your Practice

As patients look for a plan that includes your physician in their network, preparing your staff for the changes is essential. Getting ready will ensure you can spread the workload and minimize last-minute pressures that can cause errors in your patient details.  

Here are the steps you can take to gear up for the healthcare enrollment and influx of patient updates: 

• Ensure all staff receive training on handling insurance updates and understand the importance of accurate data entry.
• Assign specific staff members to handle insurance updates to streamline the process.
• Set up a process to quickly address and rectify any issues that arise from inaccurate or incomplete information.
• Regularly audit patient records to catch any errors or omissions in insurance information.

Updating Patient Records and Insurance Information

Accurate patient data is crucial for smooth reimbursement cycles, preventing claim rejections or denials. Use the checklist below to ensure your staff systematically updates relevant plan details in your electronic health record or digital patient charts.

1. Insurance coverage information

• Update patient records with any new insurance plans or changes to existing plans.
• Ensure that policy numbers, group numbers, and other insurance details are current.
• Record the date of new coverage or changes to avoid billing issues.

2. Contact information

• Update patient addresses and contact numbers to ensure you can reach them for appointments, follow-ups, or billing questions. This is especially important for patients who moved to another state or employment (subsequently changing their plans). 
• Confirm or update email addresses for communication about appointments, billing, or insurance issues.

3. Primary care physician and referrals (for specialists)

• Update records if patients switch their designated primary care physician or if there are changes in referral requirements.
• Ensure any new or updated referrals are documented and communicated.

4. Patient demographics

Verify and update personal information, such as marital status or dependents, which may affect coverage or billing.

5. Authorization and pre-certification information

Update any authorizations or pre-certifications required by the new insurance plans.

6. Billing information

Edit any changes in patient payment methods or insurance billing information.

To prevent billing errors, have your staff double-check the patient’s details before finalizing them. Keep a log of changes made to patient information for future reference and accountability.

Optimizing Patient Communication

Healthcare practices like yours can provide support to patients at any stage during open enrollment. Your patients may reach out to you for help with documents proving their eligibility for some plans, as well as enhanced subsidies. 

Other patients might inquire whether you are “in-network” for specific insurance plans. This point is valuable for patients who want to save money on out-of-pocket costs.  

Your staff can assist by explaining the coverage of the following:

• Preventive care, lab tests, surgeries, and other services under different plans, and which plan is essential for their health
• Prescriptions and generic alternatives or specific plans with lower prescription costs
• Frequency of visits for routine checkups, chronic condition management, or other services

For patients who may have trouble understanding their insurance options or updating their information, your staff can provide relevant sources, like the state’s marketplace. Or educate them in using online calculators, such as:

• ACA Health Insurance Subsidy Calculator: This calculator will estimate the patient’s premium subsidy based on income, age, and household size.
• Health Insurance Marketplace Calculator: This calculator can estimate health insurance premiums and subsidies for coverage through marketplaces.

Utilizing Digital Tools for Patient Engagement

How about patients who might’ve missed the enrollment period? Not a problem. You have the option to run an awareness campaign by your on-site staff or outsourced billing teams. They can contact these patients via email, text, or social media. 

These campaigns can be as simple as sending patients a reminder not to miss the enrollment. A billing team can set this text or email reminder through an electronic health record’s (EHR) automated reminder features.  

You can also use infographics or informational brochures that provide answers to queries, such as “When is open healthcare enrollment?” Or you can cover more practical tips that empower your patients to make the most of this period. Your staff can upload them to the EHR’s patient portal, where patients can download and read them. 

The staff can also post them on the clinic’s social media accounts and encourage them to share with folks who haven’t signed up for the enrollment. 

Tap Into Our Expertise

Guiding patients through the complexities of choosing healthcare plans is crucial. Their choice of healthcare plans can significantly affect how they pay for the care they receive, with its co-pays, deductibles, or premiums. 

Ensuring your staff is well-prepared with processes and procedures for updating patient coverage can help smooth your reimbursement cycles. Double-checking entries can save you time and ensure patients receive more attention during their visit. Your staff can also ensure that services or prescriptions will be reimbursed according to the patient’s insurance policy.

Updating data while providing patient support can be overwhelming. 5 Star Billing Services offers relief from these tasks with top-notch outsourced billing teams to help with the following:

• Training to keep your staff updated on plans and coverage 
• Managing bulk data verification and updates
• Running patient communication campaigns
• Managing digital tools for updating and communication

Call 1-480-999-0180 and experience the 5-star difference with our specialized teams! We also provide comprehensive support in billing codes and regulations while hitting collection goals and reducing claim denials. 

Optimize Your Billing During Open Enrollment

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