The insurance coverage of a patient may or may not exist at the time of treatment. This may sound strange but is often the case. Therefore, checking insurance coverage is a critical requirement that needs to be done before meting out treatment. This process is called insurance verification services. The best thing about carrying it out early is that it guarantees you payment from the insurance carrier. In case, the insurance coverage doesn’t exist, you can collect the money upfront from the patient. Thus, insurance verification in many ways, helps you keep your practices finances in the pink of health.
The Importance of Insurance Verification Services
We have partly explained the importance of insurance verification above. There are other critical ramifications as well. Sometimes, the insurance may not cover the entire cost of the treatment process. In such cases you get to know instantly as to how much the patient has to bear towards their treatment. The same can be conveyed to the patient upfront and collected in advance, else the amount might get pushed into the A/R account.
The process of verification also helps to get the latest information on the coverage. Sometimes deductibles get changed due to some reasons and the patient may not be aware of this. Insurance verification helps you inform the patient about the changes and prepare them for the out-of-pocket expenses before the treatment. This prevents relationship from souring up. Most importantly, if the patient is not able to make the payment it can help the provider draw up a proper schedule of payment.
The Checklist for Proper Insurance Verification
Healthcare providers need to ensure that verifying a coverage is all inclusive. In other words, the process must cover all details irrespective of whether it is obvious or not. This is the safest way to ensure that the reimbursement happens on time and in full amount.
An insurance eligibility verification process must enquire about the patient’s demographic details. This should be followed by exhaustive enquiry on coverage details. The common items covered here include payable benefits, plan exclusions, co-pays, co-insurance & deductibles, referrals, pre-authorizations, health insurance caps etc. Other important enquiries include claims submission address, DME coverage and out-of-network benefits.
Insurance Eligibility Verification – Important Steps
An insurance eligibility verification process must be preceded and followed by a few definitive steps. These include:
Patient Scheduling: This is the process of booking appointment for a prospective patient. This is commonly done with the help of a software or patient portal.
Patient Enrolment: This step involves entering the patient information into records. Other than personal information it also includes keying in information like their allergies, diagnosis, and other health issues.
Insurance Verification – The above two stages lay the foundation for insurance verification. All required information is gathered from the carrier company and keyed in.
Pre-Authorization- This arguably is the most important requirement to be done after establishing insurance credentials. It involves getting an assurance from the insurance company for carrying out the process.
Patient Reminders
After the completion of the above stages, the healthcare provider has to get in touch with the patients to convey them of all out-of-pocket costs and get a confirmation about associated costs that they must pay on their own.
Outsourcing Insurance Verification – The Unbeatable Advantages
The two big challenges associated with insurance verification are time and money. It is a very tedious process and hence requires a lot of time. Also, it demands manual intervention at a large scale and hence becomes costly and error-prone.
The fall out of improper insurance verification is known to all. An improper process causes errors that again turns into delayed pay-outs, expensive denials, and rise in number of A/R days. Besides, it might also involve claims reworks and re-submissions. All this has a tell-tale effect on the revenue process such as reduced cash flows and payment waive off from patients who cannot foot their medical bills.
Insurance eligibility verification outsourcing to a third-party insurance verification company can bring in many tangible and intangible benefits. Some of these include:
Reduce Risk Factors
Outsourcing insurance verification services can help you have better control over all risk factors associated with this service. The biggest risk is incorrect or incomplete verification. Third-party partners know the process end-to-end and go all out to ensure correct verification. They have proper tools and processes in place to bring about the information in a smooth way. This will ensure you are not left huge losses from non-payment. Likewise, you can reduce risk factors associated with training, attrition, change in rules etc.
Fewer Claims Rejections
Insurance eligibility verification carried out by third-party service providers, always give your services an expert touch. This is because it is handled by seasoned professionals who know what red flags to look out for when trying to know about insurance coverage. These professionals with thousands of insurance verification needs and have an instinctive understanding of what is covered and what is not. A touch of such high-level expertise means fewer claim rejections because of insurance verification issues.
Accelerated Billing Cycles
Giving your insurance eligibility verification to third-party vendors will expedite your billing cycles too. This is because these specialists know what information to seek for, which information to reconfirm, and what aspects can be excluded from a plan. Most of the times such extensive knowledge means less follow-up with insurance companies. The direct impact of this is accelerated billing cycles. This ensures your cash flow is continuous and A/R is kept at bare minimum. In house experts cannot match this efficiency at the scale desired by most large practices.
Improved Productivity
There are a few collateral benefits of outsourcing insurance verification services. One such benefit is boost in staff productivity. This is because they will have more time available to focus on other important tasks. Yet another way to look at it is that you may not have to hire more staff to get rising volumes of verification work done. All this can lead to cost savings as well. There is one more benefit. You don’t have to hunt around for skilled people to handle your process in the face of labor shortage or sudden spike in insurance verification needs.
Zero reworking on Claims
Insurance verification services can best be handled by experts. They know the job inside out and so can do it with zero errors. Therefore, when you leave this task to third-party onshore or offshore experts you take away the task of tedious rework. This can result in lot of revenue savings by the way of reworks and resubmissions. This way you can keep a check on your accounts receivables too.
If insurance verification is done the right way, it leads to a rise in the number of clean claims submitted. This helps to solve major issues like delayed payments, billing errors, and non-payment. Therefore, to straighten the RCM process, practices need to make a beginning with the insurance eligibility verification process
Who We Are What Makes Us an Expert?
This article is brought you by MedBilling Experts. We are experienced provider of all major back-office support services to practices based in the US. One of our areas of specialization is insurance verification services. We have a well-developed process of delivering healthcare verification services. We back our services with the best of software tools and knowledgeable resources. If you want to know more about our services get in touch with us now.
