In the present health care sector with several payment options and frequent changes in governmental policies and regulations, it is imperative that insurance eligibility and benefits of patients are verified prior to providing services. Not doing so leads to missing the opportunity to reduce staff time and secure income. Front office staff in physician practices need to be trained for completing this task that boosts revenue while saving time on the back end.
How does the Process of Insurance Eligibility Verification Work?
It must be made a general rule that returning as well as new patients have to bring their insurance identification card or other relevant document for each of their visits. Front office staff must check whether information on the card are correct and up to date. This can be checked with the insurance company’s website or by calling a representative.
In case there is any issue during insurance verification, policies must ensure that patients pay in full for the services provided and file insurance claim themselves. Office staff also need to confirm whether the physician is considered as in-network or out-of-network by the patient’s insurance plan.
Need for Prioritizing Insurance Verification
Verifying patients’ insurance eligibility and coverage is the primary step in maintaining the financial well-being of the medical practice. Prior insurance verification is a strong indicator of AR.
There are several ways to check eligibility, namely, on payer websites, by using software or third-party products, for providing detailed information to office staff. This helps them with AR. Such data not only includes whether patients have insurance coverage but also whether premium payment has been made and how much of deductibles have been utilized.
Details Checked During Insurance Eligibility Verification Process
- Insurance coverage date
- In-network or out-of-network coverage
- Co-pay amount, if any
- Deductible amount and how much has been met so far
- Confirming that services offered are covered or whether they need pre-authorization
Having experienced staff and appropriate processes for properly collecting patient information and checking insurance eligibility facilitates streamlined billing and claims process. Following basic protocol regarding eligibility verification ensures timely payment for health care services provided.
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