Electronic Insurance Verification – Should It Get Any Better Than This..

The healthcare landscape has evolved, and one of the primary changes is the growing financial duty of patients with high deductibles that require them to pay physician practices for services. It becomes an area where practices are struggling to collect the revenue they are entitled.

In fact, practices are generating up to 30 to 40 percent of the revenue from patients that have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact income and profitability.

One option would be to improve eligibility checking utilizing the following best practices: Check patient eligibility 48 to 72 hours well before scheduled visit using one of those three methods: Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and exercise management solutions.

Search for patient eligibility on payer websites. Call payers to find out health insurance verification for more complex scenarios, like coverage of particular procedures and services, determining calendar year maximum coverage, or if perhaps services are covered if they occur in an office or diagnostic centre. Clearinghouses tend not to provide these details, so calling the payer is essential for such scenarios.

Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients with regards to their financial responsibilities before service delivery, educating them regarding how much they’ll have to pay so when.Determine co-pays and collect before service delivery. Yet, even when doing this, you can 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.

If this all sounds like a lot of work, it’s since it is. This isn’t to express that practice managers/administrators are not able to do their jobs. It’s just that sometimes they require some help and much better tools. However, not performing these tasks can increase denials, as well as impact cashflow and profitability.

Eligibility checking is definitely the single best approach of preventing insurance claim denials. Our service begins with retrieving a summary of scheduled appointments and verifying insurance policy for the patients. After the verification is done the policy facts are put directly into the appointment scheduler for your office staff’s notification.

There are three methods for checking eligibility: Online – Using various Insurance provider websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance firms directly an interactive voice response system can give the eligibility status. Insurance Provider Representative Call- If necessary calling an Insurance provider representative will provide us a more detailed benefits summary beyond doubt payers when they are not provided by either websites or Automated phone systems.

Many practices, however, do not have the resources to accomplish these calls to payers. During these situations, it might be suitable for practices to outsource their eligibility checking to an experienced firm.

For preventing insurance claims denials Eligibility checking is definitely the single most effective way. Service shall start out with retrieving set of scheduled appointments and verifying insurance policy coverage for that patient. After nxvxyu verification is finished, details are put into appointment scheduler for notification to office staff.

For outsourcing practices must see if the following measures are taken as much as check eligibility:

Online: Check patient’s coverage using different Insurance company websites and internet payer portal.

Automated Voice System (IVR): Acquiring eligibility status by calling Insurance companies directly and interactive voice response system will answer.

Insurance carrier Automated call: Obtaining summary beyond doubt payers by calling an Insurance Company representative when enough information is not gathered from website

Inform Us About Your Experiences – What are some of the EHR/PM limitations that the practice has experienced in terms of eligibility checking? How often does your practice make calls to payer organizations for eligibility checking? Inform me by replying inside the comments section.