Healthcare practices have to carry out check medical eligibility of a patient to make sure that the services provided are covered. Most of the medical practices do not have plenty of time to carry out the difficult process of insurance eligibility verification. Providers of insurance verification and authorization services can help medical practices to dedicate enough time to their core business activities. So, seeking the help of an insurance verification specialist or insurance verifier can be very helpful in connection with this.
A trusted and highly proficient verification and authorization specialist will continue to work with patients and providers to verify medical insurance coverage. They will likely offer complete support to acquire pre-certification and prior authorizations. They have got:
Greater than 20 percent of claim denials from private insurers are the consequence of eligibility issues, based on the American Medical Association. To minimize these kinds of denials, practices can employ two proactive approaches:
The Fundamentals – Many eligibility problems that lead to claim denials are caused by simple administrative mistakes. Practices should have comprehensive processes set up to capture the necessary patient information, store it, and organize it for convenient retrieval. This includes:
Acquiring the patient’s complete name directly from the credit card (photocopying/scanning is usually recommended) Patient address and contact number Get the name and identification amounts of other insurance (e.g., Medicare or some other kind of insurance coverage involved). Again, photocopying/scanning of health insurance cards is recommended.
Looking Deeper – The increase in high deductible plans is making patients financially responsible for a bigger 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 enhance collections. To achieve this, practices want to look beyond if the individual is eligible, and figure out the extent from the patient’s benefits. Practices will need 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 underneath the patient’s policy Maximum cap on certain treatments Coordination of benefits. Practices that have a proactive method of eligibility verification is effective in reducing claim denials, improve collections, and reduce financial risks. Practices which do not possess the resources to achieve these tasks in-house may want to consider outsourcing specific tasks for 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 still a requirement for live representative calls to payer organizations.
As an example, many practices use electronic data interchange (EDI) and clearinghouses making use of their EHR and PM methods to determine if an individual is qualified to receive services on a specific day. However, these solutions are generally cgigcm to offer practices with details about:
Procedure-level benefit analysis Prior authorizations Covered and non-covered conditions for certain procedures Detailed patient benefits, such as 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 and a practice’s financial health. We are 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 much more to ensure accurate billing. When the verification process has ended, the authorization is extracted from insurance firms via telephone call, facsimile or online program.