Medical health insurance verification is the process of verifying that a patient is covered under a health insurance plan. If insurance details and demographic data is not properly checked, it could disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is recommended to assign this task to a professional service provider. Here’s how insurance verification services help medical practices.
Gains from Competent health insurance verification – All healthcare practices search for proof of insurance when patients sign up for appointments. The procedure must be completed prior to patient appointments. Along with capturing and verifying demographic and insurance information, the staff in a healthcare practice has to perform a multitude of tasks like medical billing, accounting, mailing out of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great attention to detail, and it is very difficult in a busy practice. Therefore increasingly more healthcare establishments are outsourcing health insurance verification to competent firms that offer comprehensive support services such as:
Receipt of patient schedules through the hospital or clinic via FTP, fax or e-mail. Verification of all the necessary information such as the patient name, name of insured person, relationship towards the patient, relevant telephone numbers, birth date, Social Security number, chief complaint, name of treating physician, date of service,, form of plan (HMO or POS), policy number and effective date, policy coverage, claim mailing address, and so forth. Contact the insurer for each account to confirm coverage and benefits eligibility electronically or via phone or fax
Verification of primary and secondary insurance policy and network. Communication with patients for clarifications, if necessary. Completing the criteria sheets and authorization forms. One of the greatest advantages of outsourcing this with an experienced company is they have a specialized team on the job. Having a clear understanding of your goals, the group activly works to resolve potential issues with coverage. By taking on the workload of insurance verification, they guide you and administrative staff give attention to core tasks. Other assured gains:
Companies that offer this service to aid medical practices also offer efficient medical billing services. With the right service provider, you save up to 30 to 40 per cent on your insurance verification operational costs. Today’s physician practices have more opportunities than ever to automate tasks using electronic health record (EHR) and rehearse management (PM) solutions. While increased automation will offer numerous benefits, it’s not suitable for every situation.
Specifically, there are specific patient eligibility checking scenarios where automation cannot provide the answers that are required. Despite advancements in automation, there is still a requirement for live representative calls to payer organizations.
For example, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM solutions to determine if a patient is qualified to receive services on a specific day. However, these solutions nxvxyu typically unable to provide practices with information regarding:
• Procedure-level benefit analysis
• Prior authorizations
• Covered and non-covered conditions for several procedures
• Detailed patient benefits, such as maximum caps on certain treatments and coordination of benefit information
To assemble this kind of information, an agent must call the payer directly. Information gathered first-hand by a live representative is important for practices to reduce claims denials, and ensure that reimbursement is received for the care delivered. The financial viability from the practice is dependent upon gathering this information for proper claim creation, adjudication, and also to receive timely payment.
Yet, even when carrying this out, there are still potential pitfalls, including alterations in eligibility as a result of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.