Practices may offer diagnostic ancillary services to increase revenue, or to provide more complete care for patients. Ancillary services fall into three broad categories:
- Diagnostic (e.g., X-ray or lab services)
- Therapeutic (e.g., physical therapy services)
- Custodial (e.g., nursing home or hospice services)
The Centers for Medicare & Medicaid Services (CMS) released data from more than 3,000 U.S. hospitals showing significant variations in charges for the same inpatient services.
Insurance verification validates a patient’s coverage with the third-party payer, and establishes the patient’s financial responsibility (co-insurance, co-pay, deductible, and annual out-of-pocket limits), per his or her contract with the third-party payer.
Your scheduling staff affects the profitability of your practice in many ways, including how they handle referrals. Determining the need for provider referrals prior to the patient’s arrival can mean the difference between payable or denied services. In the worst case scenario, the service may be a total write-off, if the provider is in-network with the third party payer but failed to receive a required referral prior to rendering the services.