Medical health insurance verification is the process of confirming that a patient is covered within a health insurance plan. If insurance details and demographic data is not properly checked, it can disrupt the cash flow of your practice by delaying or affecting compensation. Therefore, it is advisable to assign this task to a expert provider. Here’s how insurance verification services help medical practices.
Gains from Competent medical insurance eligibility verification – All healthcare practices search for proof of insurance when patients register for appointments. The process has to be completed before patient appointments. In addition to capturing and verifying demographic and insurance information, employees in a healthcare practice needs to perform a multitude of tasks including medical billing, accounting, broadcasting of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great awareness of detail, and it is extremely tough in a busy practice. Therefore increasingly more healthcare establishments are outsourcing health insurance verification to competent companies that offer comprehensive support services such as:
Receipt of patient schedules through the hospital or clinic via FTP, fax or e-mail. Verification of important information including the patient name, name of insured person, relationship to the patient, relevant cell phone numbers, date of birth, Social Security number, chief complaint, name of treating physician, date of service,, type of plan (HMO or POS), policy number and effective date, policy coverage, claim mailing address, and so forth. Contact the insurer for each and every account to ensure 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. Finishing of the criteria sheets and authorization forms. One of the biggest benefits of outsourcing this task with an experienced company is that they use a specialized team on the job. Using a clear comprehension of your goals, they activly works to resolve potential issues with coverage. If you take on the workload of insurance verification, they help you and also administrative staff concentrate on core tasks. Other assured gains:
Companies that offer this particular service to help medical practices also offer efficient medical billing services. Using the right provider, you can save approximately 30 to 40 % on your own insurance verification operational costs. Today’s physician practices get 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 right for every situation.
Specifically, there are certain patient eligibility checking scenarios where automation cannot supply the answers that are needed. Despite advancements in automation, there is still a necessity for live representative calls to payer organizations.
For instance, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM solutions to determine whether 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 for several procedures
• Detailed patient benefits, including 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 with a live representative is essential for practices to lessen 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 this info for proper claim creation, adjudication, as well as receive timely payment.
Yet, even if carrying this out, you can still find potential pitfalls, like modifications in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.