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Insurance Eligibility Verification

Obtain Accurate information the First time

Insurance verification is the first and most important step in the revenue cycle management. Today’s complex healthcare environment requires, more than ever, close attention to validating coverage, benefits, co-payments, and deductibles. So, it becomes crucial that medical care providers understand the insurance verification process and its importance in the healthcare industry. You can't get paid, with in accurate or, no coverage information. 

Insurance Verification Process

Simply put, 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, and confirm if their annual benefits questionnaire was completed. Failure to do so could leave your practice with an unpaid claim from the insurance company or a patient saddled with unexpected expensive bills.

The Importance of the Insurance Verification Process in Medical Billing

This is considered one of the most common causes of medical billing failure, ensuring proper insurance verification and pre-authorization enables faster and more efficient payments, reduced debts, and enhances patient satisfaction.

1. Improves Cash Flow

Accurate insurance verification ensures a higher number of clean claims which speeds up approval and results in a faster billing cycle. Inadequate verification of eligibility and plan-specific benefits puts healthcare organizations at risk for claim rejections, denials, and bad debt.

2. Minimizes Claim Rejections and Denials

Verifying the insurance coverage in advance, for procedures or equipment, results in fewer claims being denied. Since insurance information change frequently, failure to stay ahead of ever-changing regulatory requirements could lead to rejected claims, billing errors, and reimbursement delays. Healthcare providers need to be vigilant and verify the member’s eligibility every time before the services are provided.

3. Increases Patient Satisfaction

Nine in 10 consumers want to know their payment responsibility upfront. It is important to contact the patient’s insurance carrier prior to the procedure or services being rendered and ensure that it is included in the patient’s health insurance coverage. Errors in carrying out efficient insurance verification or submitting a claim for a procedure that the patient’s insurance carrier does not cover, or is delivered by providers who are outside the employee’s health insurance provider network, will leave the patient financially exposed, fearful, and frustrated. As a result, the patient will have to pay 100% for the services. This isn’t just bad for patients, but detrimental to the medical practice as well.

" We have the solutions to your revenue cycle challanges" 

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