Medical health insurance verification is the process of confirming that a patient is covered within a medical health insurance plan. If insurance details and demographic details are not properly checked, it could disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is advisable to assign this task to a professional provider. Here is how insurance verification services help medical practices.
Gains from Competent insurance verification companies – All healthcare practices look for proof of insurance when patients sign up for appointments. The process has to be completed before patient appointments. As well as capturing and verifying demographic and insurance information, the staff in a healthcare practice needs to 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 focus on detail, and it is very hard in a busy practice. Therefore increasingly more healthcare establishments are outsourcing medical health insurance verification to competent companies that offer comprehensive support services like:
Receipt of patient schedules through the hospital or clinic via FTP, fax or e-mail. Verification of all necessary information like the patient name, name of insured person, relationship towards the patient, relevant cell phone numbers, date of birth, 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 on. Contact the insurer for 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 needed. Completion of the criteria sheets and authorization forms. One of the best advantages of outsourcing this with an experienced company is that they have a specialized team on the job. Using a clear comprehension of your goals, the group activly works to resolve potential issues with coverage. By taking on the workload of insurance verification, they help you and also administrative staff concentrate on core tasks. Other assured gains:
Businesses that offer this service to assist medical practices offer efficient medical billing services. With all the right service provider, it can save you up to 30 to 40 % on the insurance verification operational costs. Today’s physician practices have more opportunities than ever before to automate tasks using electronic health record (EHR) and practice management (PM) solutions. While increased automation will offer numerous benefits, it’s not suitable for every situation.
Specifically, there are certain patient eligibility checking scenarios where automation cannot give you the answers that are required. Despite advancements in automation, there is certainly still a requirement for live representative calls to payer organizations.
For example, many practices use electronic data interchange (EDI) and clearinghouses making use of their EHR and PM methods to see whether the patient is qualified for services on the specific day. However, these solutions nxvxyu typically unable to provide practices with details about:
• Procedure-level benefit analysis
• Prior authorizations
• Covered and non-covered conditions beyond doubt procedures
• Detailed patient benefits, like maximum caps on certain treatments and coordination of benefit information
To gather this type of information, a representative must call the payer directly. Information gathered first-hand by way of a live representative is vital for practices to reduce claims denials, and make sure that reimbursement is received for all of the care delivered. The financial viability of the practice is dependent upon gathering these details for proper claim creation, adjudication, as well as receive timely payment.
Yet, even if accomplishing this, 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.