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 data is improperly checked, it can disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is best to assign this task to a expert provider. Here’s how insurance verification services help medical practices.
Gains from Competent patient eligibility verification – All healthcare practices look for evidence of insurance when patients register for appointments. This process must be completed before patient appointments. Along with capturing and verifying demographic and insurance information, the staff in a healthcare practice needs to perform a multitude of tasks like medical billing, accounting, sending out of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great attention to detail, and it is very hard in a busy practice. Therefore more and more healthcare establishments are outsourcing medical health insurance verification to competent companies that offer comprehensive support services including:
Receipt of patient schedules from your hospital or clinic via FTP, fax or e-mail. Verification of all information you need like the patient name, name of insured person, relationship for the patient, relevant telephone numbers, birth date, 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 insurance company 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 greatest advantages of outsourcing this task for an experienced company is they use a specialized team on the job. With 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 assist you and also administrative staff focus on core tasks. Other assured gains:
Businesses that offer this service to assist medical practices offer efficient medical billing services. Using the right service provider, it can save you up to 30 to 40 percent on the insurance verification operational costs. Today’s physician practices acquire more opportunities than ever to automate tasks using electronic health record (EHR) and exercise management (PM) solutions. While increased automation can offer numerous benefits, it’s not suitable for every situation.
Specifically, there are specific patient eligibility checking scenarios where automation cannot supply the answers that are required. Despite advancements in automation, there is certainly still a need for live representative calls to payer organizations.
For example, many practices use electronic data interchange (EDI) and clearinghouses using their EHR and PM answers to see whether a patient is qualified to receive 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 for certain procedures
• Detailed patient benefits, like maximum caps on certain treatments and coordination of benefit information
To assemble this type of information, an agent must call the payer directly. Information gathered first-hand by way of a live representative is important for practices to reduce claims denials, and ensure that reimbursement is received for the care delivered. The financial viability in 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 may still find potential pitfalls, such as changes in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.