Accurate patient eligibility verification is critical for practices because it impacts the time taken to get reimbursed for their services. Yet another advantage of verifying coverage in advance is that it provides practices as well as patients a fair estimate of the patient responsibility for payment. Therefore, when patients know this in advance i.e., prior to appointments, they will come to the appointment prepared to pay. This eliminates confusion or any chances of misunderstanding.
Most of the Times Patients are Incorrect about their Coverage
This is primarily because insurance wordings can be confusing which makes them interpret it wrongly. Yet another reason is insurance wordings keep changing rapidly. So more often than not, patients are not aware that their deductibles have changed or other policy changes that is directly related to their out of pockets. Therefore, the best way out is to keep patients posted so that they can create a schedule of payment for their share of costs.
The fact of the matter is that most patients want to pay their bills on time. Medical insurance verification must be leveraged as a tool by practices to help assist patients get the correct information well in advance so that they are not left dumbfounded by large bills. Sometimes insurance policies lapse or policies don’t cover the services. In such cases, verifying eligibility in advance insulates the RCM process of practices.
Verifying patient eligibility can be done in a number of ways. Each of these ways will impact the revenue stream in a number of ways. The one thing you need to keep in mind while choosing is how well will the mode of verifying the patient improve the rate of payment from both the patient and provider. Yet another important point is the amount of time it may demand from your employees – for example, manual verification will be more time consuming for your employees than electronic verification.
Insurance Verification Steps-How to Verify Medical Insurance Coverage
Collect the Patient’s Insurance Information
This may sound very simple and straight. But this is where many stumble. Getting information from patients can go wrong in many ways. For instance, you may get the age or SSN right, but key in the wrong number. Likewise, you may get the gender wrong, or the patient may mislead you by unwittingly providing an address not updated with the insurer. Sometimes, such slip-ups may happen when you are overloaded with work.
Therefore, to avoid mistakes, it is important to devote adequate time for this step. Furthermore, you need to get the process reviewed by experts. This way you can stop slip ups from passing through the crack. Therefore, the list of things, you need to do, when you collect information from the patient includes:
- Patient name and date of birth
- Name of the insurance company
- Name of the primary insurance plan holder and relationship with patient
- Name of the secondary insurance, if any.!
Dial the Insurance Carrier Much in Advance
You need to have your backs covered much before the patient walks in. This can best be done by starting the insurance verification process early. Sometimes, the verification can be over in minutes. In case it doesn’t, you get buffer time to round-off the process. Ideally, it is safe to initiate contact at least 72 hours before a patient’s initial visit.
This way you can have all the information that you need and even cross verify it with the patients, before they walk in for an appointment. This way you can even ward off mistakes that can happen due to overwork. Below are the ways in which you can get in touch with the carrier:
The most common way to get in touch with payers is through direct calls. It’s a pretty straight forward way. Find the insurance carrier’s phone number from the patient’s policy copies and dial them up. Once you get connected to a person on the other end, cross check if you’re talking to the right person. That’s because, payers have different person dedicated for different requirements.
Provide all information related to your practice to reassure the person that this is a HIPAA-secure exchange. Next provide all the patient’s information (usually the patient’s name, policy number, date of birth, etc.) as required by the person. The representative will collect the info, locate the correct policy and furnish all the details.
Explore Online Search Methods
If you find this process too cumbersome and time consuming, you can opt for the modern-day approach i.e., online search. Every payer has an online eligibility-checking resource to facilitate verification queries. And each of these checking processes is very user-friendly. So, you will be able to find the information you want in quick time.
Online search is a very self-reliant way of validating insurance claim verification. However, it comes with a catch. Sometimes, the information contained in online data bases may be outdated. This can lead to incorrect validation. While this may not be true in all the cases, it always helps to be aware of the consequences of such a possibility.
Deploy Automatic Verification Services
Automated insurance verification service is an advanced form of verification process that helps to wrap up the process in minutes and with zero chances of errors. While availing these services comes at a cost—especially when you integrate them into an EMR – it is worth it because it helps you round off the process in seconds without chances of error.
What to do After Gathering Information
Once you gather all the information, you need to record the necessary information into your EMR. Next, call the patient and provide them a copay estimate. This is important because it is a great way to earn some goodwill! Thereafter, when the patient comes for the appointment, collect and scan the patient’s insurance card and photo ID. This will ensure you have ready access to the policy number when you need, and you won’t have to bother the patient with another call.
Options Available to Carry Out Medical Insurance Verification
How to verify insurance is a challenge to many providers. The two available options before them are:
Clearinghouse Systems
This is one of the most common eligibility verification practices adopted by providers. It entails, enrolling in a system wherefrom they can check eligibility for patients irrespective of the insurance carriers. Clearinghouses serve as a one-stop platform for eligibility verification. It has found great favor with providers because it has proven to be a great time saver. It obviates the need for employees to turn to learn multiple systems to complete the verification process.
Outsourcing
Over the last decade or so outsourcing has emerged as the most viable option to eligibility verification. Many practices find outsourcing to be an optimal solution because it eliminates all clerical tasks associated with verification and delegates it to a third-party agency with expertise in insurance verification process. This way, providers stand to benefit on two counts – save countless productive hours and accomplish this critical task with greater efficiency. Besides, it helps them overcome the perennial problem of skill shortage and issues like scalability.
Conclusion
As a provider you can choose either of the two insurance claim verification methods. Irrespective of which option you choose, it’s important to have well-established insurance verification process and one that you are comfortable with to make your revenue cycle management process seamless.
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