Medical health insurance verification is the process of verifying that a patient is covered within a medical health insurance plan. If insurance details and demographic details are not properly checked, it can disrupt the cash flow of your practice by delaying or affecting compensation. Therefore, it is recommended to assign this task to a expert company. Here is how insurance verification services help medical practices.
Gains from Competent patient eligibility verification software – All healthcare practices look for proof of insurance when patients sign up for appointments. This process must be completed prior to patient appointments. As well as capturing and verifying demographic and insurance information, the staff in a healthcare practice must 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 attention to detail, and it is very difficult in a busy practice. Therefore more and 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 all necessary information including the patient name, name of insured person, relationship towards the patient, relevant phone 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 on. Contact the insurer for each account to verify coverage and benefits eligibility electronically or via phone or fax
Verification of primary and secondary insurance coverage and network. Communication with patients for clarifications, if required. Finishing of the criteria sheets and authorization forms. One of the greatest advantages of outsourcing this task with an experienced company is they use a specialized team on the job. Using a clear understanding of your goals, they works to resolve potential issues with coverage. If you take on the workload of insurance verification, they assist you and administrative staff give attention to core tasks. Other assured gains:
Businesses that offer the service to aid medical practices offer efficient medical billing services. With all the right service provider, you save approximately 30 to 40 percent on your insurance verification operational costs. Today’s physician practices get more opportunities than ever before to automate tasks using electronic health record (EHR) and exercise management (PM) solutions. While increased automation will offer numerous benefits, it’s not appropriate for every situation.
Specifically, there are certain patient eligibility checking scenarios where automation cannot give you the answers that are needed. Despite advancements in automation, there exists still a requirement for live representative calls to payer organizations.
As an example, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM answers to determine if an individual is qualified for services over a specific day. However, these solutions nxvxyu typically unable to provide practices with information about:
• Procedure-level benefit analysis
• Prior authorizations
• Covered and non-covered conditions beyond doubt procedures
• Detailed patient benefits, including maximum caps on certain treatments and coordination of benefit information
To collect this sort of information, an agent must call the payer directly. Information gathered first-hand by a live representative is important for practices to minimize claims denials, and ensure 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 though accomplishing this, there are still potential pitfalls, such as modifications in eligibility because of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.