Healthcare practices have to carry out medicare eligibility verification of a patient to ensure that the help provided are covered. A lot of the medical practices don’t have lots of time to perform the difficult process of insurance eligibility verification. Providers of insurance verification and authorization services will help medical practices to devote enough time to their core business activities. So, seeking the aid of an insurance verification specialist or insurance verifier can be extremely helpful in this connection.
A reliable and highly proficient verification and authorization specialist will work with patients and providers to verify medical insurance coverage. They will offer complete support to get pre-certification and/or prior authorizations. They may have:
Greater than 20 % of claim denials from private insurers are caused by eligibility issues, based on the American Medical Association. To reduce these sorts of denials, practices can employ two proactive approaches:
The Basics – Many eligibility issues that result in claim denials are caused by simple administrative mistakes. Practices must have comprehensive processes in place to capture the required patient information, store it, and organize it for quick retrieval. This consists of:
Getting the patient’s complete name directly from the card (photocopying/scanning is suggested) Patient address and phone number Acquire the name and identification amounts of other insurance (e.g., Medicare or any other type of insurance coverage involved). Again, photocopying/scanning of medical health insurance cards is suggested.
Looking Deeper – The rise in high deductible plans is making patients financially responsible for a larger percentage of a practice’s revenue. Therefore, practices need to know their financial risks beforehand and counsel patients on the financial obligations to improve collections. To achieve this, practices want to look beyond whether the sufferer is eligible, and figure out the extent from the patient’s benefits. Practices will need to gather additional information from payers through the eligibility verification process, like:
The patient’s deductible amount and remaining deductible balance Non-covered services, as defined under the patient’s policy Maximum cap on certain treatments Coordination of advantages. Practices that require a proactive approach to eligibility verification can reduce claim denials, improve collections, and minimize financial risks. Practices that do not hold the resources to accomplish these tasks in house should consider outsourcing specific tasks with an experienced firm.
Specifically, there are particular patient eligibility checking scenarios where automation cannot give you the answers that are required. Despite advancements in automation, there is certainly still a need for live representative calls to payer organizations.
As an example, many practices use electronic data interchange (EDI) and clearinghouses making use of their EHR and PM methods to determine if an individual is qualified to receive services on the specific day. However, these solutions are typically cgigcm to provide practices with information regarding:
Procedure-level benefit analysis Prior authorizations Covered and non-covered conditions for several procedures Detailed patient benefits, like maximum caps on certain treatments and coordination of benefit information. Implementing these proactive eligibility approaches is very important, whether practices handle them in house or outsource them, since denials as a result of eligibility issues directly impact cashflow as well as a practice’s financial health. Our company is a healthcare services company providing outsourcing and back-office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.
They will likely also contact insurance agencies/companies for appeals, missing information and much more to ensure accurate billing. Once the verification process is finished, the authorization is obtained from insurance firms via telephone call, facsimile or online program.