Eligibility Verification System – Would It Become Cheaper Than This..

Medical health insurance verification is the process of confirming that a patient is covered within a medical insurance plan. If insurance details and demographic facts are improperly checked, it could disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is recommended to assign this task to a expert provider. Here is how insurance verification services help medical practices.

Gains from Competent medical eligibility verification – All healthcare practices try to find evidence of insurance when patients sign up for appointments. This process needs to be completed prior to patient appointments. As well as capturing and verifying demographic and insurance information, employees in a healthcare practice must perform a multitude of tasks like medical billing, accounting, broadcasting of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great awareness of detail, and is also very hard in a busy practice. Therefore more and more healthcare establishments are outsourcing health insurance verification to competent companies that offer comprehensive support services such as:

Receipt of patient schedules through the hospital or clinic via FTP, fax or e-mail. Verification of information you need like the patient name, name of insured person, relationship to the patient, relevant phone numbers, date of birth, Social Security number, chief complaint, name of treating physician, date of service,, type of plan (HMO or POS), policy number and effective date, policy coverage, claim mailing address, and so on. Contact the insurance company for each and every account to confirm coverage and benefits eligibility electronically or via phone or fax

Verification of primary and secondary insurance policy coverage and network. Communication with patients for clarifications, if needed. Completion of the criteria sheets and authorization forms. One of the biggest benefits of outsourcing this task for an experienced company is that they possess a specialized team on the job. With a clear knowledge of your goals, the group works to resolve potential problems with coverage. If you take on the workload of insurance verification, they assist you and administrative staff concentrate on core tasks. Other assured gains:

Businesses that offer the service to aid medical practices also offer efficient medical billing services. Using the right company, you can save as much as 30 to 40 per cent on your own insurance verification operational costs. Today’s physician practices get more opportunities than in the past to automate tasks using electronic health record (EHR) and practice management (PM) solutions. While increased automation can provide numerous benefits, it’s not suitable for every situation.

Specifically, there are specific patient eligibility checking scenarios where automation cannot provide the answers that are required. Despite advancements in automation, there is certainly still a necessity for live representative calls to payer organizations.

As an example, many practices use electronic data interchange (EDI) and clearinghouses with their EHR and PM methods to determine whether the patient is eligible for services on the specific day. However, these solutions nxvxyu typically unable to provide practices with details about:

• Procedure-level benefit analysis

• Prior authorizations

• Covered and non-covered conditions for several procedures

• Detailed patient benefits, like maximum caps on certain treatments and coordination of benefit information

To gather this kind of information, an agent must call the payer directly. Information gathered first-hand by a live representative is important for practices to lessen claims denials, and make sure that reimbursement is received for all of the care delivered. The financial viability from the practice depends upon gathering this information for proper claim creation, adjudication, and also to receive timely payment.

Yet, even though carrying this out, there are still potential pitfalls, such as alterations in eligibility due to employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.