Successful, accurate medical billing and reimbursement begins with ensuring every patients’ insurance information is accurately captured and thoroughly verified – ideally before the start of any encounter. That’s because failing to do so can result in payment delays or more likely claims denials – which can have a significant and negative impact on reimbursement and cashflow. In an era of shrinking margins where every penny counts – ensuring you have a robust insurance eligibility verification process in place is a must.
The Process for Insurance Eligibility Verification
While it sounds simple, the process for verifying insurance coverage isn’t always easy. There are several steps involved – and for organizations and providers that are contracted with numerous payers with multiple health plans, it can get confusing and complicated very quickly.
For each patient, it’s essential to verify coverage status, active or inactive status, and eligibility status. Capturing the patient’s complete insurance information at the time of scheduling is the first step in the process. From there, verifying eligibility, insurance coverage, covered services, and benefits is next, but this isn’t a process that can be done once a year – checking coverage and benefits prior to each encounter is vital since factors such as changes in employment, a birth, a marriage, and/or a divorce can change a patient’s coverage, benefits, and status.
The problem? This process can be very time-consuming and even complicated for busy physician practices and health systems. It requires a dedicated team ( often grappling with manual processes) to focus on reviewing and aligning schedules, verifying coverage by scouring payer web sites, using interactive voice response systems, calling and following-up with the payer multiple times, reaching back out to the patient to obtain more complete and/or updated information, etc.
Insurance Eligibility Verification – Is Outsourcing the Answer?
While some organizations choose to manage this process internally, it can be overwhelming and time-consuming. Here are a few benefits to outsourcing insurance eligibility verification.
- Reduces Claim Denials – Research shows that approximately 40% of claims denials are due to insurance coverage-related problems. In these cases, if patients truly aren’t covered, oftentimes the provider has to either pursue the patient for payment or even write off the charges as bad debt. Neither scenario is ideal in a world where a reliable eligibility verification process would have avoided the problem altogether. Outsourcing organizations have the expertise, staff, and extended hours of coverage to ensure the proper information is collected and fully verified every visit.
- Improves Patient Satisfaction – When coverage and benefits aren’t properly verified in advance, patients often don’t know or understand their financial obligations. With the rise of high-deductible plans, increased co-pay and co-insurance payments, and the mandate of pricing transparency, patients expect to be fully informed prior to a visit, procedure, service, or other encounter. If patients receive a surprise bill after the fact, not only are those bills less likely to be paid, but the patient is less likely to return for future services – leading to a double negative impact on the bottom line. Experts in eligibility verification know how to translate coverage and eligibility information into usable information that can help patients understand their financial responsibilities ahead of time and collect those payments prior to services being rendered.
- Streamlines Reimbursement – Doing the necessary work to verify eligibility, coverage, and benefits up front can make all the difference when it comes time to send a claim out the door. Clean claims are those that are paid without errors and most quickly – which means more cash in the bank sooner and it will also reduce days in A/R. Improvements in cashflow during challenging financial times can help struggling practices and health systems to not only survive, but to also thrive.
- Allows Staff to Focus on Patient Care – Let’s face it, no matter what is happening around us, the healthcare environment is always a busy and hectic place to be. Providers, office staff, and back-office teams are always going to be busy going in a million different directions. Outsourcing the multiple functions of insurance eligibility verification can free up healthcare teams to do what they are meant to do – focus on healthcare.
GeBBS Healthcare Solutions provides a wide range of Eligibility Verification and Pre-Authorization services, specializes in next generation revenue cycle management to help increase cash flow and speed medical billing processes. To learn more visit: www.gebbs.com
