How to get faster VOBs and longer stays for clients

bed-1078919Nothing is more frustrating — or revenue draining — than having a client come into your residential substance abuse treatment center on a Saturday only to find out on Monday that you can’t bill for the services you just provided. Only slightly less frustrating (and challenging to revenue) is when an insurance company denies the level of care or length of stay your client really needs.

Inspira works with insurance companies across the United States, so we know what insurance companies are likely to authorize or deny. We also know how much they are likely to reimburse you. Using our tools, your intake department can immediately see a projection of whether or not a client’s insurance will cover your services. You will also see what tests or diagnoses the insurer will likely require and an estimate of the length of stay and level of care. You will then get confirmation of our estimate within 24 hours, including verification of benefits and pre-authorizations.

Having an indication of what an insurance company pays for particular plans means you have better visibility into what your reimbursement is going to be. That means you can provide services to a client without the worry that they don’t have the benefits needed to pay you.

How verification of benefits (VOBs) work

When a potential client calls into your facility’s intake department, they provide demographic and insurance information like subscriber ID, Social Security number, date of birth, address, etc. Your intake department will prompt the client to call their insurance company to provide consent for insurance information requests. Their insurance information is then provided to Inspira’s Verification of Benefits Specialist.

Inspira’s Verification of Benefits Specialist will obtain insurance information for all levels of substance abuse care, MAT services, psychological and neuropsychologist testing your client is likely to need. If any insurance information provided by the intake department is missing or incorrect, our VOB staff will include this information in the VOB summary and alert the intake department that updated information is needed. Within 1 hour of the VOB Specialist receiving an accurate request, benefits will be verified and sent to your intake department.

How the pre-authorization process works

Your intake department can call the client with verification and complete a clinical pre-assessment within one hour. The intake coordinator can then determine a preliminary level of care based on clinical information, ASAM, and medical necessity criteria. Available facilities will be identified based on a daily bed census, patient preference, and proposed admit date. This information is forwarded for review to the General Manager and the Clinical Director of your facility, as well as the assigned Utilization Review Coordinator at Inspira.

Your staff and our UR team will collaborate to ensure the client will receive optimum covered days. Inspira’s UR staff will call in to obtain preauthorization at the earliest 24 hours prior to admission (per insurance standards) using the completed pre-assessment form as well as previous clinical charts when available.

Pre-authorizations received prior to 2pm Pacific Time will be completed prior to the end of the requested day. Pre-authorizations received after 2pm or which come from insurance companies on Eastern Time will be completed the following day.

Once pre-authorization is complete, all the details will be recorded in your EMR system, including start and end dates, level of care authorized, number of authorization days, authorization number, concurrent review date, and the Care Manager’s name and contact information (if available). An email will also be sent to your facility reiterating authorization information and Care Manager feedback pertaining to the episode of care.

Inspira can help get faster VOBs and longer stays for your clients

To learn more about how Inspira ensures your clients get the treatment they need, contact us today. We would be more than happy to help you!