Healthcare practices have to handle electronic eligibility verification of a patient to make sure that the assistance provided are covered. Most of the medical practices don’t have lots of time to perform the difficult procedure of insurance eligibility verification. Providers of insurance verification and authorization services may help medical practices to devote ample time to their core business activities. So, looking for the help of an insurance verification specialist or insurance verifier can be very helpful in this regard.
A reliable and highly proficient verification and authorization specialist will continue to work with patients and providers to confirm medical care insurance coverage. They are going to offer complete support to acquire pre-certification or prior authorizations. They have got:
Greater than twenty percent of claim denials from private insurers are the result of eligibility issues, based on the American Medical Association. To minimize these sorts of denials, practices can employ two proactive approaches:
The Fundamentals – Many eligibility problems that bring about claim denials are the result of simple administrative mistakes. Practices should have comprehensive processes set up to capture the essential patient information, store it, and organize it for convenient retrieval. This consists of:
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 amounts of other insurance (e.g., Medicare or any other type of insurance policy involved). Again, photocopying/scanning of all the medical insurance cards is usually recommended.
Looking Deeper – The increase in high deductible plans is making patients financially responsible for a larger portion of a practice’s revenue. Therefore, practices need to know their financial risks beforehand and counsel patients on their financial obligations to boost collections. To accomplish this, practices want to look beyond whether the patient is eligible, and find out the extent in the patient’s benefits. Practices will need to gather further information from payers through the eligibility verification process, including:
The patient’s deductible amount and remaining deductible balance Non-covered services, as defined underneath the patient’s policy Maximum cap on certain treatments Coordination of advantages. Practices that have a proactive strategy to eligibility verification can reduce claim denials, improve collections, and minimize financial risks. Practices which do not hold the resources to accomplish these tasks on-site 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 necessity for live representative calls to payer organizations.
For example, many practices use electronic data interchange (EDI) and clearinghouses using their EHR and PM answers to determine if the patient is qualified for services on the specific day. However, these solutions are typically cgigcm to provide practices with details about:
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 as a result of 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 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.