Verifying insurance eligibility and its effectiveness are critical to growth in the healthcare industry. Although practices are struggling to build a solid financial foundation today, claim denials have increased. Many reasons can be given for denying a claim, thus procedures must be skilled enough to reduce these.
A good patient eligibility and benefits verification services is essential to a successful and effective practice. Here is how you, as a provider, can meet today’s issues, lower denials, and improve the healthcare revenue cycle as a whole.
Each patient’s insurance information needs to be carefully examined and validated by the practice prior to the visit. That keeps the refunds coming and reduces confusion. Furthermore, any issues that are discovered during the earliest stages of insurance verification can be resolved.
Claim Refusals and Typical Refusal Grounds
Claims are refused for a variety of reasons. Among the most popular explanations are:
- insurance policy that has ended or terminated
- Benefits coordination not updated
- Services not covered
- advantages exhaustion
- Reached plan limit
- pre-authorization or referral missing
- inaccuracy in patient data
- Insufficient policy information
- Mandatory information that is either missing or wrong
In addition to these explanations, other circumstances might also be plausible. Yet, your practise needs a robust verification process if you wish to prevent denials for the reasons indicated above.
Steps to an efficient medical insurance verification
1. Get an insurance card
The entire procedure begins there. By requesting the patient’s insurance card or a copy of the current records, your practice must start the process of health insurance verification. A fundamental document that determines the outcome of what is about to happen is an insurance card. Even if a patient has previously supplied a copy of their insurance card, it is safer to request the most recent version.
2. Comply with the lis
All necessary data must be recorded after you have obtained the copy. Any discrepancy may result in a denial. Below is a list of the data you need to record:
- Patient Name
- Primary Insured Person’s name
- Insurance providers name
- Insurance number
- Group ID Number
- Whether the practice of the provider is enrolled with the payor
- Policy period
- Policy coverage
- Copay and deductibles details
- Policy service coverage
- Preauthorization details for treatments, specific procedures, and medical services
3.Contact the Insurance Provider
Calling the payor to confirm the details you’ve recorded once you have all the information is a wise move. If there is a discrepancy, now is a great moment to find it and fix it. The data can be downloaded more quickly using the electronic download option.
4.Record complete and accurate information
Make sure your team gets the patient and insurance provider to supply all the pertinent information regarding the insurance. When recording any data pertaining to patients or their claims, exercise extra caution. One small mistake can result in a denial. The personnel should be extremely cautious in managing this phase because it is the most important milestone.
5.Connect with the patient- whenever required
During the verification process, if you need any explanations or have any problems, you should not be afraid to get in touch with the patient and ask questions. The importance of open lines of contact with patients should never be understated. All information regarding deductibles, copays, coverage gaps, etc. must be shared with the patient. It will hasten the schedule for collection and prevent any last-minute shocks.
Verifying eligibility is essential for a strong healthcare revenue cycle solution. To reduce bother and boost reimbursements, your clinic requires a solid backend partner for fewer denials and quicker claims.