Insurance Verification – Why It Is Important
It is yet another busy day at your practice. Your staff is engaged in the many tasks that demand immediate attention. The phones are ringing with anxious patients at the other end desperate for an appointment. At times like these, your staff may not have time to verify the patient’s insurance details before giving an appointment date. Surely you need a helping hand to take care of this very important insurance eligibility verification. The only way to ensure that all your claims get paid is by checking the patient’s eligibility and coverage before an appointment. Physicians can easily do this now with reliable eligibility management services provided by medical billing companies in the US.
75% of Claim Denials Stem from Ineligibility of Patients
Industry sources reveal the shocking fact that seventy-five percent of claim denials are due to the patient not being eligible for the services provided. Sometimes the patient’s insurance plan may have been modified or even terminated. Proceeding to provide medical services without ascertaining insurance eligibility will result in claim denials, delayed payments, rework, increased errors and patient dissatisfaction. So the wise step is to let a knowledgeable medical billing company do the verification for you. Medical professionals must understand the importance of medical billing as well as its individual components such as insurance verification, authorization and coding in making the billing process successful.
Insurance Verification Services – What to Expect
Insurance verification services include checking a patient’s active coverage with the insurance company and verifying whether the patient is eligible for the procedure scheduled in the hospital. Insurance verification specialists identify whether or not the insurance is active, what co-payments and deductibles are due, whether a referral/authorization is needed to guarantee payment to the physician and whether certain services will be covered by insurance.
Health insurance verification also includes verification of: payable benefits, patient policy status, effective date, type of plan and coverage details, plan exclusions, claims mailing address, referrals & pre-authorizations, life time maximum, and more. Insurance eligibility verification process involves many steps which are mentioned below:
- Receiving patient schedules from the hospital or clinics via FTP, email or fax
- Verifying patients’ insurance coverage on all primary and secondary (if applicable) payers
- Verifying demographic information
- Updating patient accounts
- Contacting patients for additional information if necessary
- Updating the billing system with eligibility and benefits details such as member ID, group ID, coverage start and end dates, co-pay information
How Outsourcing Companies Can Help
Today, there are several outsourcing companies that provide insurance verification services.
- A dedicated company can help you reduce your accounts receivable cycle and increase revenue.
- You partnering firm will see to it that only “clean” claims are submitted to the insurance company. Claims are clean in the sense that they are complete in every respect and are only for those patients who are eligible for coverage.
A comprehensive research on the internet could help you decide which outsourcing companies are most appropriate for your medical insurance verification needs.
To avoid claim rejection, it is very important to carry out the insurance benefit verification process before the patient is admitted to a hospital. Confirming the health insurance eligibility of the patient prior to rendering services will help you save administrative as well as financial hassles later.
About The Author
Outsource Strategies International (OSI) is a leading insurance authorization company that offers a range of services to meet the needs of its clients. We provide insurance authorizations and health insurance verification services to practices of any size and specialty.
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