In today’s continually changing and complex healthcare environment, it becomes crucial for healthcare providers to understand insurance verification.
There have been millions of claims denied because the plan has expired or because the patient or service was not covered by the plan. Establishing a robust insurance review process can reduce the number of such denials in your practice, making your medical billing practices more efficient and improving your overall bottom line.
Now, most Americans have insurance plans. Therefore, it is necessary to verify your patient’s eligibility before providing any treatment. Moreover, it is important that your staff confirm how your patients are going to pay.
Your patient’s insurance verification plan should be done before the patient gets admitted to the hospital, clinic, or any medical facility. If you fail to do so then you will end up with claim rejections and denials by the insurance company.
And we understand that filing for claims rejection is such a hassle and very time-consuming that will prevent providers from giving quality care to patients. So, in this blog, we provide you the steps of Insurance Eligibility verification that you should follow in order to avoid constant eligibility-based denials.
What is Insurance Eligibility Verification?
Insurance verification is the process of contacting the insurance company to determine whether the patient’s healthcare benefits cover the required procedures. Also, it is necessary to complete insurance verification before a patient receives medical services. Failure to do so could leave your practice with an unpaid claim from the insurance company or a patient saddled with unexpected expensive bills.
Steps To Verify Patient Insurance
Insurance Verification Checklist
It is important to train your front staff to ask the right questions during insurance verification. The front office staff must enter information from the insurance card, phone calls to the insurance company, or the electronic eligibility system. The information that is included in each patient’s electronic medical record include:
- Insurance name, phone number, and claim address
- Insurance ID number
- Name of Insured because it is not always patients. Also, the relationship of the insured to the patient
- Start date of the Insurance policy
- The end date of the Insurance policy
- Insurance coverage is currently available or not
- Whether the insurance covers all the procedures and services that are to be rendered
- Include all the exclusions or documentation requirements for bill
- Required pre-authorization certificate for payment
- Patient’s copay and deductible amount
Must-Have A Copy Of The Patient’s Insurance Card
For the insurance eligibility process, it is good to ask for a copy of the patient’s insurance card. You should start your insurance eligibility verification process by insurance card copy to know the updated information about the patient’s insurance.
The up to date image of either side of the insurance in the electronic medical record has an informational backup if someone incorrectly enters the insurance policy information inside the card. The health care providers should double-check the ID amounts against the cards before submitting claims.
Contact the Insurance Provider
Even if you take a copy of a patient’s insurance card don’t forget to contact the insurance Provider because there might be chances that insurance coverage may have changed or discontinued. For this reason, you should contact an insurance provider to ensure eligibility. You can place a call by using the provider hotline that is provided by the payer or use your integrated EMR and billing system for eligibility verification. Moreover, an electronic eligibility verification system is the most efficient for payers.
You just need to put data directly into electronic medical record systems in order to make your process faster or to avoid any possible data errors.
Record Correct Information
Educate your office staff to be extra cautious when recording information in the patient file. The information forms the basis for a medical claim, and one transplanted number can mean the difference between a clean claim and a denial.
Hasty insurance policy confirmation and data errors can wait for payments for days or weeks, or a claim may go completely outstanding, which is awful for any health practice.
Patient Follow Up When Required
Follow up with your patients about insurance information is necessary to get paid faster. If there are any questions or concerns then you need a patient follow-up. You can do this simply by using a patient portal to inform patients about eligibility through emails or other online communications. It is the best option as it reduces all your concerns regarding eligibility verification.
When you inform a patient as early as possible it is possible that you will collect all funds on time.
If you still have confusion about patient eligibility information then our team at MED-MILES LLC is here to help you in every matter. Call us for information about setting up connectivity with insurance providers to verify eligibility from your integrated EMR and medical billing software.