Medical health insurance verification is the process of verifying that a patient is covered within a medical 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 provider. Here’s how insurance verification services help medical practices.
Gains from Competent health insurance verification – All healthcare practices try to find proof of insurance when patients register for appointments. The procedure must be completed prior to patient appointments. As well as capturing and verifying demographic and insurance information, the staff in a healthcare practice must perform an array 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 medical insurance verification to competent businesses that offer comprehensive support services such as:
Receipt of patient schedules from the hospital or clinic via FTP, fax or e-mail. Verification of necessary information like the patient name, name of insured person, relationship towards the patient, relevant phone numbers, date of birth, Social Security number, chief complaint, name of treating physician, date of service,, kind of plan (HMO or POS), policy number and effective date, policy coverage, claim mailing address, and so on. Contact the insurer for each and every account to verify coverage and benefits eligibility electronically or via phone or fax
Verification of primary and secondary insurance policy coverage and network. Communication with patients for clarifications, if necessary. Finishing of the criteria sheets and authorization forms. One of the biggest advantages of outsourcing this task to an experienced company is that they use a specialized team on the job. Having a clear comprehension of your goals, the group functions to resolve potential issues with coverage. By taking on the workload of insurance verification, they help you and administrative staff give attention to core tasks. Other assured gains:
Businesses that offer this service to help medical practices also provide efficient medical billing services. With all the right provider, you save up to 30 to 40 per cent on your insurance verification operational costs. Today’s physician practices have more opportunities than in the past to automate tasks using electronic health record (EHR) and practice management (PM) solutions. While increased automation will offer numerous benefits, it’s not appropriate for every situation.
Specifically, there are certain patient eligibility checking scenarios where automation cannot provide the answers that are needed. Despite advancements in automation, there is still a necessity for live representative calls to payer organizations.
For example, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM methods to determine if the patient is qualified to receive services over 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 beyond doubt procedures
• Detailed patient benefits, including maximum caps on certain treatments and coordination of benefit information
To collect this type of information, a representative must call the payer directly. Information gathered first-hand by a live representative is important for practices to minimize claims denials, and ensure that reimbursement is received for all the care delivered. The financial viability in the practice is dependent upon gathering this information for proper claim creation, adjudication, and also to receive timely payment.
Yet, even if doing this, you may still find potential pitfalls, like changes in eligibility because of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.