INSURANCE VERIFICATION

A vital process of confirming that a patient’s insurance plan covers the services provided.  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.

The insurance verification process is critical in the healthcare industry to ensure that patients receive the right care, at the right time, and without any disruptions. This process involves confirming a patient’s insurance information and checking their healthcare benefits to determine what their policy covers. By doing so, healthcare providers can reduce the risk of fraud, minimize denied claims, and improve patient satisfaction.

Verification Prevents Deception​

Deception is a major problem in the healthcare industry, and proper insurance verification helps prevent it by ensuring that claims are only submitted for covered treatments and procedures. Verifying insurance information in advance also reduces the risk of denied claims by submitting correct information to the insurance company, minimizing the chance of errors or inaccuracies.

The Importance

The insurance verification process is crucial for several reasons. Firstly, it improves cash flow by reducing the likelihood of denied claims and ensuring correct insurance information is submitted, reducing the chance of payment delays or inaccuracies. Secondly, it minimizes claim rejections and denials, ensuring patients receive care without interruption. Finally, it increases patient satisfaction by clarifying insurance coverage and enabling informed decisions about care.

The Risk

Inadequate verification of eligibility and plan-specific benefits increases the risk of denied claims, billing errors, and reimbursement delays. Verifying insurance coverage in advance results in fewer denied claims and reduces the chance of billing errors.

The Outsourcing options

For healthcare organizations lacking the resources or expertise to manage insurance verification in-house, outsourcing to a medical billing company can be a solution. Accurate verification by a medical billing company can speed up approval and authorization, ensuring patients receive care on time and without disruptions.

The insurance verification process is essential for the healthcare industry. It helps ensure patients receive the right care, on time, and without disruptions. By verifying insurance information in advance, healthcare providers can improve cash flow, minimize claim rejections and denials, increase patient satisfaction, and reduce the risk of fraud.

ACTIVITY DESCRIPTION

  • • Calling the respective insurance company
  • • Breakdown Form Completion
  • • Updating Details Appointment Notes
  • • Review and Appointment Confirmation in PMS
  • • Providing Office Manager with a daily EV Summary Report

KEY DELIVERABLE

  • • All Verifications completed 48 Hours prior to appointment
  • • All related notes entered into the PMS
  • • All related notes entered into the PMS
  • • Creation and submission of a daily ‘EV Summary Report’