If you have heard the expression, putting the cart before the horse, then realize that skipping Insurance Eligibility verification before a patient sees the healthcare provider is just like that. In simple terms, Insurance Eligibility verification is a process to confirm the coverage and benefits that a patient’s insurance company provides and whether it will pay for certain treatment procedures, lab work, or medications.
Insurance Eligibility verification is critical to avoid claim rejections and must be done as the first step to:
- Determine the service charges and responsibility that the patient and the insurance provider have to share to pay for healthcare services.
- Ensure accurate and timely receipt of information regarding insurance coverage.
Verifying Insurance Eligibility Involves:
- Accurately recording personal information of the patient and their insurance coverage
- Contacting Insurance Provider, confirming the policy, and obtaining Pre-authorization(s) if needed
- Following up with the patient, if needed, and updating the billing system
- Ensuring the Insurance Provider pays for the services it guaranteed in its policy
Verifying the Insurance Eligibility offers clinicians a clear view of the patient’s coverage that determines the type of treatment they can provide to the patient while minimizing the patient’s financial burden.
Medical insurance should be always be verified before the clinical visit.
While Insurance Eligibility verification is critical to ensure the services rendered are paid for, it is a genuinely tedious task, consuming a lot of time and effort. Lapse in Insurance Eligibility verification can result in delays with the patient’s visit, claim denials and rejections, and delayed reimbursement. Many recently-concluded studies have confirmed that the primary reason for claim denials is the failure in verifying insurance coverage, which makes it imperative for healthcare facilities to outsource their Insurance Eligibility verification process to an experienced team. Let’s take a look at 5-major benefits of outsourcing the Insurance Eligibility verification service.
- Streamlining verification, saving time and effort
Outsourcing Insurance Eligibility verification to an adept team of qualified professionals allows you to streamline the workflow, right from recording the patient’s personal information and calling the insurance company to the documentation of the recent updates in the insurance policies, if any.
The expert team will provide the following Insurance Eligibility verification process to validate your claims, reduce denials and minimize any unnecessary delays, enhancing your organization’s revenue flow:
- Schedule Appointments
- Maintain up-to-date medical records for further documentation
- Identify patient’s responsibility before the clinical visit
- Verify thoroughly the Insurance Eligibility and Coverage details.
- Follow up calls to the patients
- Obtain Prior-authorization/Pre-certifications
- Record/update verification details into the billing system
- Check claims for missing or erroneous data and update the same
- Determine treatment service per the insurance coverage
- Minimize claims denials and delays
When you outsource your Insurance Eligibility task, an expert team helps the submission of cleaner claims. They are specifically trained in identifying erroneous data that allows them to reduce rework on claims. They are well versed in following up with insurance providers in ascertaining prior authorization(s). Further, the team constantly remains updated with the regulatory policy changes. Claims are filed with accuracy, leading to a compressed revenue cycle and increased reimbursement.
- Optimize reimbursement and enhance patient satisfaction
A professional team verifying Insurance Eligibility ensures that it has the updated information on the patient’s insurance coverage. Hence, it becomes easier for the organization to discuss coverage with the patient and inform them if there is any change in policy concerning the scope of coverage. Also, it increases the chances of submitting cleaner claims, resulting in provider and patient satisfaction. As the claims are processed and promptly accepted, healthcare providers and facilities are reimbursed in faster, optimizing the A/R cycle.
- Avoid in-house burden
An outsourced Insurance Eligibility team of professionals has the requisite knowledge, training, and skill set to offer swift Insurance Eligibility verification, ensuring minimal claim Turnaround Time. It means you do not have to worry about spending in-house resources to hire, train and manage staff on completing such a daunting and critical task.
- Cost-Effective Service
An offshore company would certainly provide the Insurance Eligibility verification service of optimum quality at cost-effective rates. It is because they have the infrastructure, reliable team, and other resources in place for a while that they have been updating to become more effective. It helps them process your claims swiftly and precisely at competitive costs.
Streamline Insurance Processors & Reimbursements with ScribeEMR
ScribeEMR provides highly qualified professionals to research relevant information regarding the insurance coverage of a patient, streamlining the entire process and optimizing A/R cycle. Insurance Eligibility verification is done well in advance of the clinical visit. Eligibility is double-checked with the insurance provider, and discrepancies, if any, are conveyed to the patient and clinical team. Our professionals are able to assess automated eligibility verification using advanced RPA tools, thus working efficiently.Well-trained experts gather useful information by paying attention to the details, ensuring extraordinarily low rate of insurance denials.