Managing a mental/behavioral health facility has often been described as “jumping from crisis to crisis”. Whether it’s facing the ongoing business development and marketing challenges, recruiting key clinical talent, keeping in touch with alumni, handling IT issues, and making payroll each month, it’s probably an understatement to say that you’ve got your hands full.
Of course, there are only so many hours in the day and efficiency is important. However, facilities that try to rush the VOB process to avoid losing out on key admits, often end up making costly mistakes that result in lost time and money. So where do people go wrong?
First, let’s discuss what a VOB is, and why it’s so important:
What is a VOB?
A verification of benefits (or VOB) is actually a business process designed to obtain critical information about a patient’s insurance benefits directly from the payer in order to determine if a policy is active, what the patient responsibility is, whether the policy covers your services, and more. A proper VOB process will answer key questions about a patient’s coverage, and make sure you get reimbursed for services provided. Each payer has their own rules and ways of communicating about benefits which adds to the complexity. Since claims get submitted a week or more after a patient is admitted, failing to obtain a complete and accurate VOB will put you on the hook to cover the cost of any services provided that are not covered or get denied.
Tech Needs a Team
Electronic insurance eligibility solutions can help admissions teams make better guesses about a prospective patient’s insurance coverage, particularly after-hours and on weekends. But as convenient as these tools can be, they are NOT a replacement for a fully “called in” VOB. Carve outs, exclusions, accreditation requirements, and prior treatment history are all factored into whether a patient will be covered, but are often not accounted for in “instant VOBs”. So when you think you’ve found an edge and secured a profitable admit, you could just be fast tracking a scholarship. Now if your program is large enough and doing well, you may be able to stretch the budget and accommodate them. But for smaller programs, or those without significant financial backing, that patient might need to be discharged at the time when they need help the most.
Incomplete is a Failing Grade
Many traditional billing companies promise VOBs in less than 1 hour. On the surface this sounds great. But insurance payers understand that the less information you have about a policy, the more leverage they have against you. The VOB can even be used by the payer to deny a claim on appeal, so being thorough isn’t an academic effort. It can be the difference between getting paid for the services you provide, or not. So, when insurance payer hold times often exceed 45 minutes, how can billers promise such a quick turnaround time?
Our research shows one of two scenarios:
1. Bad: The biller misses their service level agreement (SLA) and delivers the VOB later than promised.
2. Worse: The biller simply asks fewer questions in an effort to meet the deadline.
Making empty promises and missing deadlines is not good business practice and may signal other problems are ahead. But, if your biller is asking fewer questions, the quality of your VOBs could be costing you tens of thousands of dollars per year!
Prosperity Puts Process to Work for You
Prosperity has a very well-defined process for obtaining VOBs from every insurance payer and focuses on both efficiency and efficacy so no time is wasted, and nothing is missed. In fact, we have spent years refining our VOB form, which includes more than 100 questions to ensure that every admissions decision our clients make can be made with the confidence that there is no wiggle room for payers to get out of reimbursing submitted claims.
Here is a diagram of our VOB process:
Any process is only as good as the person carrying it out. Prosperity hires experienced staff members and trains them extensively so they know how to ask the right questions in creative ways and cross-check the answers, in order to obtain all the necessary information from even the most tight-lipped or misleading payer representatives.
To see how your VOBs compare to the Prosperity Verification of Benefits, contact us today!