Medical insurance verification is the process of verifying 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 best to assign this task to a professional company. Here is how insurance verification services help medical practices.
Gains from Competent insurance verification companies – All healthcare practices look for evidence of insurance when patients register for appointments. The process must be completed before patient appointments. Along with capturing and verifying demographic and insurance information, the employees in a healthcare practice must perform an array of tasks such as medical billing, accounting, broadcasting of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great attention to detail, and is also extremely tough in a busy practice. Therefore more and more healthcare establishments are outsourcing medical insurance verification to competent companies that offer comprehensive support services including:
Receipt of patient schedules through the hospital or clinic via FTP, fax or e-mail. Verification of all the information you need such as the patient name, name of insured person, relationship towards the patient, relevant telephone numbers, date of birth, Social Security number, chief complaint, name of treating physician, date of service,, kind of plan (HMO or POS), policy number and effective date, policy coverage, claim mailing address, and so forth. Contact the insurance company for each account to confirm 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. Completing the criteria sheets and authorization forms. One of the biggest features of outsourcing this task to an experienced company is they have a specialized team on the job. Having a clear comprehension of your goals, they activly works to resolve potential problems with coverage. If you take on the workload of insurance verification, they assist you and also administrative staff give attention to core tasks. Other assured gains:
Businesses that offer this particular service to assist medical practices offer efficient medical billing services. Using the right service provider, it can save you as much as 30 to 40 percent on your insurance verification operational costs. Today’s physician practices acquire more opportunities than in the past to automate tasks using electronic health record (EHR) and exercise management (PM) solutions. While increased automation can offer numerous benefits, it’s not right for every situation.
Specifically, there are certain patient eligibility checking scenarios where automation cannot give you the answers that are required. Despite advancements in automation, there exists still a requirement 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 determine if a patient is qualified to receive services on a specific day. However, these solutions nxvxyu typically not able to provide practices with details about:
• 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 gather this kind of information, an agent must call the payer directly. Information gathered first-hand by a live representative is important for practices to reduce claims denials, and make sure that reimbursement is received for all of the care delivered. The financial viability in the practice depends upon gathering this information for proper claim creation, adjudication, as well as receive timely payment.
Yet, even when accomplishing this, 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.