Insurance Verification Process to Check Patient's Coverage
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Insurance Verification Process to Check Patient’s Coverage

30Oct
Read Time: 6 minutes

If you are curious to know about insurance verification process then you’re in the right place.

Insurance verification is the process used by healthcare providers to verify the patient’s insurance coverage and it is the first step of medical billing process.

Insurance verification process includes deductibles, policy status, plan exclusions, and any other items that affect cost and coverage. Skipping this process could leave your practice with an unpaid claim or a denied claim from the insurance companies or a patient burdened with unexpected costly medical bills.

Insurance verification process will be done before patient is admitted to the hospital and it is important for both healthcare providers and patients and is not always the easiest process to navigate.

A recent report found that healthcare providers spent an average of 30 percent of their annual income in the insurance claim verification process.

The National Academy of Medicine (NAM) estimated that the United States BIR cost is 496 billion, 50% in excess. The solution? more stringent Insurance verification

BIR costs are administrative costs that include the overhead costs for the health insurance industry and providers’ costs for health insurance claim submission, claims reconciliation, and payment processing.

The NAM report further estimated that 66 percent of BIR costs for private insurers and 50 percent of BIR costs among providers are excess.

Your healthcare organization or practice is probably incurring admin costs that are double what they should be!!

The good news is that there is a solution – verifying insurance claims before service can help unlock value and arrest revenue leakages.

Reason for Claim Denials in Insurance Eligibility Verification Process

The primary reason of claim denials in insurance eligibility verification process are:

  1. missing patient data
  2. claim billing errors
  3. expired policies
  4. coverage effective
  5. termination dates, and
  6. duplicate data.

These always result in claim denials, non-payments, claim rework, delayed payments, and could result in additional costs to the provider and the patient. Resulting in decreased revenue, patient dissatisfaction, and in these days of YELP and Google reviews, can even tarnish the reputation of the provider.

How does the claims verification process work?

Is your practice affected by spiraling admin costs?

Is your organization swamped with insurance claim errors, claim denials, and unpaid patient treatment costs?

Are you wasting precious time on the insurance claim process when you could spend time providing healthcare for your patients?

Verifying insurance can make healthcare practice more comfortable, safer, and more rewarding for your organization. (If you have any issues in finding an outsourcing partner, then check out this guide.)

What should healthcare providers do?

Healthcare providers can eliminate setbacks by collaborating with the right outsourcing partner to assist and support the claim process and ensure a smooth revenue cycle management.

The right partner would:

  • Create streamlined and transparent processes
  • Provide expert guidance
  • Ensure steady cash flow
  • Minimize staff workloads
  • Be cost-effective
  • Understand HIPAA security and CMS regulations and guidelines

To see a comprehensive picture of insurance eligibility verification benefits, check out here.

This briefly explains creating transparency and streamlined processes through outsourcing insurance eligibility verification services.

Claim process in Insurance Eligibility Verification

Insurance eligibility Verification involves many complicated and time-consuming steps.

▪ Receiving patient schedules from the hospital
▪ Verifying with the insurance company the extent of coverage
▪ Reaching out to patients in case further information is called for
▪ Keeping the billing system updated with insurance verification and eligibility details such as member and group ID, start and end dates for coverage, co-pay information.

Should your practice spend time, money, and effort on processing claims and following up with insurance eligibility verification companies for reimbursement when your resources can be better utilized to provide healthcare to your patients?

1. Patient Enrollment

It all starts with healthcare specialists providing patient data to their outsourcing partner. There, experts scrutinize the patient’s data and use it to begin the insurance eligibility verification process.

2. Insurance Eligibility Verification

The most significant reason for claim denial is incomplete or missing data.

An outsourcing partner should always ensure they have the most complete and up-to-date information. This happens by reaching out to the patient’s insurance provider. Some of the reasons a patient’s coverage may have changed are marriage, childbirth, or divorce.

Outsourcing insurance verification specialist will connect with primary and secondary payers to get a detailed view of the patient’s coverage. They will cross-check insurance coverage details to ensure the maximum claim will be met.

A providers outsourcing partner will send all of the up-to-date coverage information to them so they can notify the patient of their insurance eligibility status and any additional payment needs. Medical care providers will also be given pre-authorization from insurance providers before any treatments.

3. Patient Follow up

Timely appointments and treatments are a must in claim verification process

By deploying automation tools, patient follow-up is simple. Using automation solutions and services, patients can receive notifications, emails, texts, or phone calls regarding upcoming appointments and treatments. In the case of appointment cancellation, patients will receive an instant notification and rescheduling options. All of this serves to enhance the patient experience and create satisfaction with their healthcare provider.

4. Updating the Billing System

Your outsourcing partner billing team will ensure the insurance verification process has been entered correctly in the provider’s billing system. A partner well-versed in the entire revenue and treatment cycle can ensure that all of the patient’s data are recorded properly from the initial appointment to final discharge.

Benefits of outsourcing Health Insurance Eligibility Verification

1. Enables ease of business

The insurance eligibility verification process maximizes value by minimizing claim denials and rejections.

Since insurance regulation is subject to change, failure to stay abreast of such changes could result in your business having to cope with rejected claims, billing errors, or even delays in reimbursement. Remember, healthcare providers, need to verify the patient eligibility every time before providing medical services.

2. Increases patient satisfaction

Patients need to know how far they can rely on their medical insurance coverage and whether or not they may need to dip into their own pockets for medical treatment. Unless efficient insurance verification is carried out, the patient may be exposed to financial risk, which is damaging for both the patient and the medical practice. The complexity of verifying insurance claims often leads to costly mistakes that can be avoided by taking advantage of service providers with expertise.

3. Addresses safety concerns

Hospitals store a vast database of information relating to patients. Data worth a lot of money to hackers who can sell it unscrupulously on the dark web.

Organizations are becoming increasingly susceptible to online attacks. Why do you think cyberattacks often target the healthcare industry?

Today, medical records fetch up to ten times more money on the dark web than the credit card.

This requires organizations to pay special attention to cybersecurity. A successful cybersecurity plan requires an organization to closely establish and manage trusted digital identities throughout the digital healthcare enterprise.

Sufficient insurance verification ensures built-in safeguards to ensure privacy and security.

4. Increases revenue generation and improved cash flow

Healthcare providers can opt for accurate Medicare verification (as well as processing claims to other federal and private insurance providers) to avoid the pitfalls of insurance claims, increase collections, and avoid bad debt.

Every healthcare practice should pay attention to insurance verification services as a means of positively impacting its bottom line while entrusting the complicated, time-consuming, and error prone claim procedures to a insurance verification specialist.

When your practice outsource insurance verification services to specialists, your raison d’être viz. healthcare can be your primary focus.

Technology to the rescue – digital identity

Insurance verification can be strengthened by incorporating Digital Identity Verification for patients to ensure that they are who they say they are using technology.

A digital ID is not something that exists; it must be created with trust and then managed, protected, secured, and shared in the appropriate conditions.

What is digital identity verification?

When an individual walks into a bank to open an account or enters a hotel to book a room, or even approaches an agency to rent a car, he needs to prove his identity by showing his government issued ID and proof of address. The service provider needs physical evidence that they are who they say they are, and the company doing business with them needs to be convinced to complete the transaction.

Now let’s flip to the digital world. Even when an individual is not physically present, insurance verification companies need to verify who they are and ensure their digital identity is good.

Digital identity insurance verification to be useful as a tool should encompass the proof of a person’s digital identity using a digital solution.

With more than four billion people presently having internet access and globally internet penetration estimated to have reached 60% by the end of 2020, there is a growing opportunity for value creation through digital ID.

McKinsey Global Institute’s Report on Digital Identification estimates that digital ID could unlock economic value up to 4% of GDP in the US in 2030 and up to 13% in some emerging economies. Institutions are slated to benefit from improved customer registration, with onboarding cost reductions of as much as 90 percent.

You, as a healthcare provider, are unfortunately part of the $496B problem. But technology now allows you to be part of the solution.

A journey of a thousand miles must begin with a single step. When you take that first step, you ensure you are moving towards destination time and cost savings.

Concluding Thoughts:

With a streamlined insurance eligibility verification process, a medical care provider not only ensures steady cash flow, but they also see higher degrees of patient and employee satisfaction. It’s often advantageous for providers to seek help from outsourcing partners who specialize in the insurance verification process.

Are you looking to outsource insurance eligibility verification services? With our Premium Patient Insurance Verification Solution , iTech can help you gain more efficiency in your revenue management cycle.

With a proven track record and skilled experts, the iTech insurance verification team is among the best. iTech offers services that are specific to each client’s needs. iTech maintains a strong HIPAA practice, is SOCII certified, and complies with all CMS guidelines and regulations. Call us or email us to find out more.


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