Cashless enhancement requests: when to send them and what to attach
An enhancement sent late turns into a deduction at discharge. Send it as soon as the plan or the stay changes.
The amount approved at admission is an estimate. When the treatment changes or the patient stays longer, the hospital must ask the insurer to increase it. That request is called an enhancement.
When to send one
- The length of stay goes beyond the days in the original estimate.
- A procedure is added, or the planned procedure changes.
- The patient moves to the ICU or needs a costlier treatment.
- The running bill crosses the approved amount, or is about to.
What to attach
- A short note from the treating doctor on what changed and why.
- The new reports that support the change.
- The interim bill and a revised estimate to discharge.
Do not wait for discharge
An enhancement that reaches the payer with the final bill is reviewed in a hurry, at the point when everyone wants the patient to leave. Send it the day the change happens.
Track the approved amount against the running bill
Keep the approved amount visible to the billing team every day, so an enhancement is sent before the bill crosses it, not after.
More from the blog
Documents required for a cashless claim: the complete hospital checklist
The documents insurers and TPAs ask for most often, grouped by the desk that owns them, so nothing is missing when the file is sent.
Cashless claim process in a hospital: a step-by-step guide for the TPA desk
From the patient at the admission counter to the money in the hospital account: the eight steps of a cashless claim, and where each one goes wrong.