Healthcare practices have to handle medical insurance eligibility of a patient to make sure that the services provided are covered. A lot of the medical practices don’t have plenty of time to perform the difficult procedure of insurance eligibility verification. Providers of insurance verification and authorization services may help medical practices to devote enough time to their core business activities. So, looking for the help of an insurance verification specialist or insurance verifier can be quite helpful in this regard.
A trusted and highly proficient verification and authorization specialist works with patients and providers to verify health care insurance coverage. They are going to provide complete support to get pre-certification or prior authorizations. They may have:
More than twenty percent of claim denials from private insurers are caused by eligibility issues, according to the American Medical Association. To minimize these kinds of denials, practices can employ two proactive approaches:
The Basics – Many eligibility problems that bring about claim denials are the consequence of simple administrative mistakes. Practices must have comprehensive processes in position to capture the necessary patient information, store it, and organize it for convenient retrieval. This can include:
Getting the patient’s full name right from the credit card (photocopying/scanning is suggested) Patient address and telephone number Acquire the name and identification numbers of other insurance (e.g., Medicare or other type of insurance coverage involved). Again, photocopying/scanning of all the health insurance cards is usually recommended.
Looking Deeper – The increase in high deductible plans is making patients financially responsible for a larger amount of a practice’s revenue. Therefore, practices need to know their financial risks in advance and counsel patients on the financial obligations to improve collections. To achieve this, practices need to look beyond whether the patient is eligible, and find out the extent in the patient’s benefits. Practices will have to gather further information from payers throughout the eligibility verification process, like:
The patient’s deductible amount and remaining deductible balance Non-covered services, as defined beneath the patient’s policy Maximum cap on certain treatments Coordination of advantages. Practices that have a proactive method of eligibility verification is able to reduce claim denials, improve collections, and reduce financial risks. Practices that do not hold the resources to accomplish these tasks in-house may want to consider outsourcing specific tasks with an experienced firm.
Specifically, there are specific patient eligibility checking scenarios where automation cannot provide the answers that are needed. Despite advancements in automation, there is certainly still a requirement for live representative calls to payer organizations.
For example, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM methods to determine whether an individual is eligible for services over a specific day. However, these solutions are generally cgigcm to supply 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. Implementing these proactive eligibility approaches is important, whether practices handle them in house or outsource them, since denials as a result of eligibility issues directly impact cash flow along with a practice’s financial health. Our company is a healthcare services company providing outsourcing and back-office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.
They are going to also communicate with insurance agencies/companies for appeals, missing information and much more to make certain accurate billing. After the verification process is finished, the authorization is taken from insurance companies via telephone call, facsimile or online program.