Medical health insurance verification is the process of verifying that a patient is covered under a medical insurance plan. If insurance details and demographic facts are improperly checked, it may disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is advisable to assign this task to a expert company. Here’s how insurance verification services help medical practices.
Gains from Competent real time insurance eligibility – All healthcare practices look for proof of insurance when patients register for appointments. This process has to be completed before patient appointments. As well as capturing and verifying demographic and insurance information, the staff in a healthcare practice must perform a range of tasks such as medical billing, accounting, sending out of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great awareness of detail, and is also very difficult in a busy practice. Therefore a lot more healthcare establishments are outsourcing medical insurance verification to competent businesses that offer comprehensive support services such as:
Receipt of patient schedules from the hospital or clinic via FTP, fax or e-mail. Verification of all necessary information including the patient name, name of insured person, relationship for 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 insurer for each account to ensure 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 necessary. Finishing of the criteria sheets and authorization forms. One of the best benefits of outsourcing this task for an experienced company is they have a specialized team on the job. With a clear knowledge of your goals, they works to resolve potential problems with coverage. Through taking on the workload of insurance verification, they help you and also administrative staff focus on core tasks. Other assured gains:
Companies that offer the service to help medical practices also offer efficient medical billing services. Using the right service provider, you save up to 30 to 40 percent on your insurance verification operational costs. Today’s physician practices acquire more opportunities than ever before to automate tasks using electronic health record (EHR) and rehearse 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 give you the answers that are required. Despite advancements in automation, there is certainly still a necessity for live representative calls to payer organizations.
For instance, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM answers to see whether the patient is qualified to receive services on a specific day. However, these solutions nxvxyu typically not able to provide practices with information regarding:
• Procedure-level benefit analysis
• Prior authorizations
• Covered and non-covered conditions for several 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 a live representative is important for practices to minimize claims denials, and ensure that reimbursement is received for 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 carrying this out, there are still potential pitfalls, like alterations in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.