Welcome Sheet Sample- Your Aid to Complete Verification....

If you want to assure 100% claim reimbursement, the Welcome Sheet is your first line of defense against billing errors and claim denial.  It is simple to use and quickly becomes your reference to patient demographics and insurance information.   I believe that a complete Welcome will provide your practice with your best chances for reimbursement and the initial time it takes to use this tool will not only give your billing department a clean claim, but also cut down on your accounts receivable and follow up calls to Medicare and the private insurance companies.

                                        Welcome Sheet Sample

Dr. 1       Dr. 2      Dr. 3       Dr. 4     ( please circle )

Part 1

Date of Patient Appointment                               Todays Date:

Patient Name :                                                     Date of Birth:

Social Security Number :                                    Address :

Phone :       Home :                 Work:                  Cell:

E- Mail Address:

Employer : 

Referring Provider :                                            Phone: 

Guarantor :                                                         Date of Birth:

Guarantor Social Security Number :

Part 2     Are we par with the patients insurance :      Y           N 

Primary Insurance :                                           ID Number :  

Group Number :                                                Effective Date:

Co - Payment Amount :                                    Co-Payment For Testing: 

Out of Network Benefits :                                Deductible Met : 

Referral Required :  

Authorization Needed For Testing :

Phone Number For Authorization :

Phone and Mailing Address For Claims :

Part 3  

Secondary Insurance :                                      ID Number : 

Group Number :                                              Effective Date: 

Co- Payment Amount :                              Co-Payment For Testing:  Y    N 

Out of Network Benefits :                               Deductible Met:

Authorization for Testing : 

Mailing Address For Claims : 

You may want to add an additional section tailored to your specialty:  This may serve as a sample for

testing for a Cardiology Practice :

What are the Pre-certification Requirements for : 

Nuclear Stress Testing :          Echo :      Carotid :    AAA :   Vascular :

Comments : 

Employee Name :                              Provider Representative Name : 

Medicare and many private insurers will allow you to use their automated systems to acquire the information for your Welcome Sheet.  However if you need to schedule a test or procedure, I believe that it is absolutely necessary to speak to a Provider Representative to make sure that the patient is covered and that you have obtained the correct authorization that applies to the test or procedure.  

EHR systems that contain auto-eligibility will make it even easier to use the Welcome, but many of the smaller labor locals or union plans are not aligned with these systems, so it will be necessary to make a phone call to avoid billing problems.   Plans that are secondary to Medicare may have their own requirements for testing or procedures, so make sure all information for the secondary insurance is complete.  

If you use one sheet of paper in the new paperless society ( frankly I had more paper than ever before! ) I believe you should use the Welcome Sheet.   I cannot stress the impact that its use had on our accounts

receivable.  Every claim went out clean and there were no questions as to eligibility or pre-certification.

My Welcome Sheets were printed on colored paper so they were easy to find in the patients chart.  If you no longer utilize a chart, I would recommend that a front desk employee or office manager print all encounters before they go to the billing department.   The daily completed Welcome Sheets can be kept in a folder along with any paper authorizations or referrals and these should be attached to the billing sheets at the end of each day.    A complete package should also include a daily schedule.

    

Don't forget to include your add-on or emergency patients.  The five minutes that it takes to complete a Welcome Sheet will save countless hours for the billing department.    Electronic eligibility features for your EHR system will require that you pay for this service as part of your monthly support.  For a large practice, this feature may vary from a single price to a charge for each physician.  Check with your vendor as these fees can be expensive.  

Welcome Sheets should be updated every 3 months and older Welcomes should be marked : NO LONGER VALID.

Using the Welcome Sheet can save your practice from serious revenue loss and can also help to make your staff more involved in assuring that all claims are clean and that they are part of the team assuring that the practice has a standard of excellence that involves all employees working together.

Tomorrow :    Where is the Referral ?????