Healthcare practices have to carry out real time insurance eligibility of a patient to make certain that the services provided are covered. The majority of the medical practices do not have plenty of time to carry out the difficult procedure of insurance eligibility verification. Providers of insurance verification and authorization services will help medical practices to dedicate ample time to their core business activities. So, seeking the assistance of an insurance verification specialist or insurance verifier can be quite helpful in this connection.
A trusted and highly proficient verification and authorization specialist will work with patients and providers to confirm medical insurance coverage. They will likely also provide complete support to obtain pre-certification and prior authorizations. They have:
More than 20 % of claim denials from private insurers are the result of eligibility issues, according to the American Medical Association. To reduce these kinds of denials, practices can employ two proactive approaches:
The Basics – Many eligibility problems that result in claim denials are the consequence of simple administrative mistakes. Practices will need to have comprehensive processes in position to capture the essential patient information, store it, and organize it for easy retrieval. This includes:
Acquiring the patient’s complete name straight from the credit card (photocopying/scanning is usually recommended) Patient address and telephone number Get the name and identification amounts of other insurance (e.g., Medicare or any other type of insurance policy involved). Again, photocopying/scanning of 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 find out their financial risks ahead of time and counsel patients on their financial obligations to boost collections. To achieve this, practices need to look beyond whether or not the patient is eligible, and find out the extent of the patient’s benefits. Practices will have to gather more information from payers during the eligibility verification process, including:
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 take a proactive method of eligibility verification is able to reduce claim denials, improve collections, and minimize financial risks. Practices which do not have the resources to accomplish these tasks on-site should consider outsourcing specific tasks for an experienced firm.
Specifically, there are certain patient eligibility checking scenarios where automation cannot provide the answers that are needed. Despite advancements in automation, there exists still a need for live representative calls to payer organizations.
As an example, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM solutions to see whether a patient is qualified for services over a specific day. However, these solutions are typically cgigcm to offer practices with information regarding:
Procedure-level benefit analysis Prior authorizations Covered and non-covered conditions for several procedures Detailed patient benefits, including 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 caused by eligibility issues directly impact cash flow along with a practice’s financial health. We have been 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 will also communicate with insurance agencies/companies for appeals, missing information and a lot more to make sure accurate billing. Once the verification process has ended, the authorization is obtained from insurance providers via telephone call, facsimile or online program.