Healthcare billing and financial processes are ever changing and Rachel Dallmann, Director of Revenue Cycle, is tasked with leading the teams involved in managing these processes at Phelps Memorial Health Center. As healthcare systems continue to evolve, Dallmann offers these bits of guidance to individuals in the south-central Nebraska and northern Kansas area:
“One of the biggest issues we see at Phelps Memorial is Medicare Advantage plans and the difficulties that come with them,” Dallmann said. “Medicare Advantage plans replace traditional Medicare and require authorizations before all inpatient stays and the vast majority of outpatient procedures. Traditional Medicare only requires authorization on a handful of outpatient procedures and, at this time, does not require authorization for inpatient stays.”
Authorizations are a pre-approval that insurance companies often require doctors or hospitals to gain before the insurance company will agree to cover the costs for a procedure or medication.
Dallmann suggests individuals reach out to Phelps Memorial’s admissions and billing teams and their primary care provider’s office before making decisions on enrollment for medical plans, as these facilities can clarify network statuses and offer local perspectives of the effectiveness of all types of plans.
“Each year, individuals have the opportunity to change plans during open enrollment, whether that be at your employer or through a private insurance agent,” Dallmann said. “If you enrolled in a Medicare Advantage Plan during your initial enrollment period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to original Medicare (with or without a drug plan) within the first 3 months you have Medicare. All insurance payers update their policies throughout the year, so there’s a chance a procedure or drug that didn’t require authorization at the beginning of the year could require authorization later in the year.”
“Another common issue is a lack of understanding, from a patient standpoint, whether their insurance is in-network with us,” Dallmann said. “There are insurance companies that have narrow networks or specific hospitals that patients can go to for services. We have found that patients often don’t understand their options when it comes to these plans.”
According to Dallmann, Phelps Memorial Health Center is currently in-network with United Healthcare, Blue Cross and Blue Shield, Aetna, Medica, Dept. of Veteran Affairs, Medicare, Midland’s Choice, NE and KS Medicaid and their Managed Care plans, First Health Network, Three Rivers, Provider Network of America, Celtic, GSIP (Nursing Home MCR Advantage).
The Phelps Memorial Health Center revenue cycle team is comprised of 30 teammates responsible for centralized scheduling, admissions, billing, financial assistance, and health information management.
“The insurance world can be very complex, and we welcome any and all questions from individuals as we work to improve the patient journey through the healthcare system,” Dallmann said.
For more information, please contact our revenue cycle team at 308-995-2211.