Health insurance verification is the process of verifying that a patient is covered within a medical health insurance plan. If insurance details and demographic facts are improperly checked, it can disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is recommended to assign this task to a professional company. Here is how insurance verification services help medical practices.
Gains from Competent medical insurance eligibility – All healthcare practices search for proof of insurance when patients sign up for appointments. The process has to be completed just before patient appointments. As well as capturing and verifying demographic and insurance information, employees in a healthcare practice has to perform a range of tasks such as medical billing, accounting, sending out of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great attention to detail, and is very difficult in a busy practice. Therefore increasingly more healthcare establishments are outsourcing medical health insurance verification to competent firms that offer comprehensive support services like:
Receipt of patient schedules from the hospital or clinic via FTP, fax or e-mail. Verification of necessary information including the patient name, name of insured person, relationship to the patient, relevant cell phone numbers, birth date, 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 forth. Contact the insurance company for every account to confirm 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 needed. Completion of the criteria sheets and authorization forms. One of the best advantages of outsourcing this for an experienced company is because they use a specialized team on the job. With a clear understanding of your goals, the team activly works to resolve potential problems with coverage. If you take on the workload of insurance verification, they guide you and administrative staff focus on core tasks. Other assured gains:
Businesses that offer this service to aid medical practices also provide efficient medical billing services. With all the right service provider, it can save you approximately 30 to 40 percent on your insurance verification operational costs. Today’s physician practices have more opportunities than ever to automate tasks using electronic health record (EHR) and exercise management (PM) solutions. While increased automation will offer numerous benefits, it’s not right for every situation.
Specifically, there are particular patient eligibility checking scenarios where automation cannot give you the answers that are required. Despite advancements in automation, there exists still a necessity for live representative calls to payer organizations.
As an example, many practices use electronic data interchange (EDI) and clearinghouses using their EHR and PM answers to see whether the patient is qualified to receive services on a specific day. However, these solutions nxvxyu typically not able to provide practices with information regarding:
• Procedure-level benefit analysis
• Prior authorizations
• Covered and non-covered conditions for several procedures
• Detailed patient benefits, including maximum caps on certain treatments and coordination of benefit information
To collect this kind of information, an agent must call the payer directly. Information gathered first-hand by a live representative is vital for practices to minimize claims denials, and make sure that reimbursement is received for the care delivered. The financial viability from the practice depends upon gathering this info for proper claim creation, adjudication, and also to receive timely payment.
Yet, even when carrying this out, there are still potential pitfalls, including modifications in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.