Medical health insurance verification is the process of verifying that a patient is covered under a medical health insurance plan. If insurance details and demographic details are not properly checked, it may disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is best to assign this task to a professional service provider. Here is how insurance verification services help medical practices.
Gains from Competent medical eligibility verification system – All healthcare practices look for proof of insurance when patients sign up for appointments. The process must be completed just before patient appointments. As well as capturing and verifying demographic and insurance information, the employees in a healthcare practice has to perform a range of tasks including medical billing, accounting, mailing out of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great awareness of detail, and is also extremely tough in a busy practice. Therefore increasingly more healthcare establishments are outsourcing health insurance verification to competent businesses that offer comprehensive support services like:
Receipt of patient schedules through the hospital or clinic via FTP, fax or e-mail. Verification of all 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 on. Contact the insurance company for 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 needed. Finishing of the criteria sheets and authorization forms. One of the biggest features of outsourcing this to an experienced company is that they use a specialized team on the job. Using a clear understanding of your goals, the group activly works to resolve potential problems with coverage. If you take on the workload of insurance verification, they guide you and also administrative staff focus on core tasks. Other assured gains:
Businesses that offer this particular service to help medical practices also offer efficient medical billing services. With the right service provider, you can save up to 30 to 40 percent on your insurance verification operational costs. Today’s physician practices get more opportunities than in the past to automate tasks using electronic health record (EHR) and rehearse 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 supply the answers that are required. Despite advancements in automation, there is still a requirement for live representative calls to payer organizations.
As an example, many practices use electronic data interchange (EDI) and clearinghouses making use of their EHR and PM answers to see whether an individual is eligible for services on 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 beyond doubt procedures
• Detailed patient benefits, such as maximum caps on certain treatments and coordination of benefit information
To collect this type of information, a representative must call the payer directly. Information gathered first-hand with a live representative is vital 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 depends upon gathering this information for proper claim creation, adjudication, and to receive timely payment.
Yet, even if doing this, you can still find potential pitfalls, like modifications in eligibility because of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.