For any hospital to be a successful organization it is very important to have a core team that looks after the financial aspect of the organization. Medical professionals are oftentimes engaged in work where they have to look after the patients and chart out a treatment plan for them. It would be unfair and stressful for them to look at the financial aspect of the organization as well. A well-managed team ensures that all the details of the patients are included in the filed claims which will not get denied. One of the most important roles that the front desk plays, being a core part of the management team, is the fact that they make sure that the patient eligibility is clear.
Juggling every patient’s insurance payer, receiving calls about all the scheduled doctor’s appointments are some of the important tasks that are handled by the hospital staff on a daily basis. It is tedious work and if not done right, it can lead to many issues, later on, one of them being claim denials.
How Important Is Patient Eligibility Verification?
It is of vital importance that your staff confirms the mode of payment the patient is going to opt for. In medical billing healthcare the majority of the patients have a health insurance plan that covers their medical expenses. The medical staff have to make sure that if a patient is choosing to go for a health insurance plan then they must be clear on the patient eligibility front. It is the duty of the staff to verify the patient’s insurance eligibility before providing any specialized treatment to the patient. If the management team does not follow this rule your organization can end up with unpaid claims by the insurance company.
Why Is It Important to Verify Insurance Eligibility and Process Pre-certification Before the Patient Receives Medical Services?
Choosing to go for experienced medical billing and coding professionals will be beneficial for your hospital. Third-party companies who have been in this business for many years know how to train their staff on a regular basis so that they remain well informed about the process that exists within insurance verification. Of course, the amount of people that you do hire will be contingent on the size of your medical organization. The core team should be capable of processing and managing claims with the insurance payers quite easily.
Without proper insurance verification, your healthcare facility is bound to suffer from claim denials which is why for any organization to become successful, it is imperative to have an experienced management team. It is crucial to verify patient medicare eligibility before the patient gets admitted to any healthcare facility, which can reduce the chances of claim rejection. When it comes to the claim rejection filing it can be quite time-consuming and tedious. Even the simplest errors that can often go unlooked can lead to claim denial.
1. Maximizes Reimbursement and minimizes claim denials;
An insurance verifier makes sure that he clears the benefits verification process along with the insurance eligibility verification. Being one of the most important parts of the administrative and management staff they take care of all the important paperwork, verifies the information of the patients and helps in the facilitation of an improved revenue cycle. They ensure that the following items remain verified and much more:
1. Co-insurances
2. Co-pays
3. Deductibles
4. Payable benefits
5. Effective date
6. Status of the patient policy
7. Coverage details included in the chosen medical plans
8. Mailing address for the claims
9. Plan exclusions
10. Pre-authorizations and referrals
2. The Process of Insurance Verification
There are several steps that are included in insurance eligibility verification, all of which are equally important.
1. Receiving the schedule of the patient from the healthcare facility, medical practice or any clinic.
2. Verifying the coverage for the patient’s health insurance.
3. Contacting the patient for extra information that could be useful.
4. Updating the medical billing system with all the verification and eligibility criteria including the group ID, member ID, starting and ending dates of the insurance plan, information regarding co-pay, etc.
3. Outsourcing from a trust-worthy service provider
In order to reduce the workload of the front desk staff, outsourcing the services for insurance verification is the best way to go. There are a number of third-party medical billing healthcare facilities that help in easing out the burden of the insurance eligibility verification. Not only can the outsourcing company help in the proper processing and management of the medical claims but they do so in an accurate manner. They ease out the burden of insurance verification. A medical outsourcing company helps in the proper billing and processing of the medical claims. The following benefits are provided by insurance verification companies.
1. Speeding up the process of authorization and approval
2. Major reduction in operational costs
3. Improvement in staff productivity
4. Speedy billing cycles
5. Simpler workflow process
6. Reduction in time and effort
When newer patients come, it is the job of the insurance eligibility verification companies to confirm several information regarding their health insurance:
1. Name of the primary person who is insured
2. The date of birth and the name of the patient
3. Insurance carrier
4. Primary insured person’s social security number
5. ID number
6. Phone number, email-id of the health insurance company
7. Group number
Therefore, when you look at it in a nutshell, there are a lot of benefits and importance that insurance verification provides. Other than that, the importance of patient eligibility criteria is also there. The entire process helps in the improvement of the healthcare facility’s financial well-being. In order to avoid errors that can cost a lot of money to the institution, re-checking the insurance coverage twice or thrice is always a good idea.
This way, you will be sure of all the details that can help in the processing of the claims in a much smoother manner. In case you are looking for a company that offers medical billing services, Synergy HCLS can be a great option to consider.
