Insurance eligibility verification services are an essential part of the medical billing process. The process involves checking a patient’s active coverage with the insurance company and verifying whether he/she is eligible for the procedure which is scheduled in the hospital. Health insurance verification is not difficult but it is a time consuming process that requires attention to detail. With their busy working schedules, most healthcare providers do not get the time to carry out the verification process properly. Outsourcing insurance eligibility verification services to a reliable outsourcing company is the best alternative.
Insurance Verification – An Effective Way to Maximize Collection
Insurance companies sometimes make policy changes and updates in their health plans. This makes it necessary for the provider to check if the patient is covered under the new plan to ensure maximum benefit.
The verification process should be done before the patient is admitted to hospital. By ensuring that patients are eligible for services and benefits before treatment is rendered avoids the risk of not getting paid.
Billing the wrong insurance carrier or not having correct patient information are issues that could result in claim rejection, which ultimately affects your bottom line. There can be many reasons for this. First, the patient may supply the wrong or outdated information. Another reason could be because his or her policy has been terminated or modified. Lack of proper eligibility often lead to problems such as:
• Delayed payments
• Increased errors
• Need for rework
• Nonpayment of claims
• Patient dissatisfaction
Therefore the process must be handled properly.
Established outsourcing firms help to maximize the collections of healthcare practices – both from patients and payers. Practices seeking the help of outsourcing firms do not have to be concerned about lost revenue due to delays or errors in patient eligibility verification. They see that all the procedures are completed on time and take care of the entire paperwork to ensure speedy reimbursement.
Benefits
The benefits of outsourcing your verification requirements are:
• Improved cash flow
• Reduced costs
• Increased efficiency
• Increased upfront collection
• Improve patient satisfaction
• Increased staff productivity
• Increased number of clean claims
• Reduced rejections and denials
Most of the outsourcing companies have the right combination of skilled professionals and advanced technology to manage all complicated medical billing follow-up functions. Billing companies have insurance verification specialists to take care of the necessary procedures and provide accurate information. These specialists possess:
• Knowledge of insurance, healthcare terminology, and medical/surgical techniques
• Excellent computer skills
• Call center/customer service experience
The verification process involves many steps. The details verified by the specialist during the eligibility verification process include:
• Payable benefits
• Co-pays
• Co-insurances
• Deductibles
• Patient policy status
• Effective date
• Type of plan and coverage details
• Plan exclusions
• Claims mailing address
• Referrals & pre-authorizations
• Life time maximum, and more
Process of Health Insurance Verification
Insurance eligibility verification services involve these steps.
• Receiving patient schedule from the hospital via EDI, email or fax
• Checking patient’s insurance coverage with primary and secondary payers
• Contacting patients for further information, if necessary
• Updating the billing system with eligibility and verification details such as, coverage end and start dates, member ID, group ID, co-pay information and much more.
To obtain the best level of insurance eligibility verification services, it is necessary to choose a reliable and experienced company. A comprehensive research could help you decide which outsourcing companies are most appropriate for your medical eligibility verification needs. It is also important to ensure that the company you choose is HIPAA compliant and has proper measures in place to ensure security and privacy.