Just imagine! You give complete care and treatment to the patient only to know that the major procedures you performed were not covered by their insurance. Now either you get the payment from the patient or forget the payment forever.
Avoiding these circumstances is important, which increases the need for insurance verification. Without a proper eligibility check, your claim is almost dead even before it started. There are a lot of terms needed to be taken care of while checking the patient eligibility.
A lot of checks must be done such as verification of benefits, coverage, pre-authorizations, etc. Presnenting the insurance ID card does not signify eligibility. It is the responsibility of the provider to verify the current enrollment status before providing care to patients.
Eligibility verification allows you to go deeper and find out exactly what is covered by the insurance. This helps you determine a specific line of benefit or services that you believe needs to be performed for the patient. Before providing care make sure that the service is covered under the member's plan.
Let's Learn About Some Basics About Eligibility Verification
Insurance verification might not be as detailed as you need. This is why insurance companies are required to review the diagnosis and all the considerations included on your claim to confirm that the treatments are covered.
To do an eligibility check or verification of benefits, you will need some basic information such as patient name, date of birth and Insurance member ID.
If you want to check the eligibility of any specific procedure, you will need more details. Also check if the specific ICD-10, CPT, or HCPCS codes are covered in the insurance.
How To Verify Insurnace Benefits Online
One of the efficient ways to check for eligibility is to directly go to the payer portals and websites. A lot of insurance companies allow providers to enter the information directly into their portal.
You can look for “Member Services” or “Provider Portal” to find the payer’s eligibility and benefits tools.
To access the payer website, you will need to enroll with a plan and register with the tool. Be aware that sometimes the registration can take time to get up and running.
Partner with a Clearinghouse
If your practice accepts different insurance plans and providers, you might need to explore a more centralized option. There are several tools like Availity and Ability Network which makes it possible to check large number of payers in one portal.
This helps providers to get information from multiple payers in one place rather than operating on multiple portals or websites.
If you partner with a clearinghouse for submitting your claims, it is very likely that they have an eligibility verification tool. The process might not give detailed information, but you will know if the procedure you are about to perform is covered within insurance or not.
Some clearinghouses can offer batch process to run multiple eligibility checks at once. For example: your practice might check the insurance eligibility of all patients on the schedule for the week.
This process takes some time to complete the run. Be prepared for it!
Contact the Payer on Call
One of the common ways to contact the payers is to call them. You will get the information from the info provided by the patient. After confirming that you are talking to the right person you will have to provide some proof of adherence to HIPAA guidelines. They will ask you to provide some of the patient’s information so they can locate the correct policy you are looking for.
It is just like any customer helpline where you can ask for information, and they will provide you with it. There can be times when you might have to wait and times when you will be connected instantly. Keep this in mind!
Gather All the Benefits Information & Record it in Your EMR
Now that you have a payer representative on the line, get out your verification checklist and gather the must-know details that will help you side-step claim denials. You can ask these questions get the information needed:
- Could you please confirm the patient’s policy and group number, the name of policy holder, and the relation of policyholder to the patient?
- Is the policy active and what’s the end date?
- Can you confirm the claim address?
- What are the patient’s copays or coinsurance?
- Are there any limitations to the coverage limit or the documentation I need to be aware of?
- What is the patient’s deductible?
Although keep in mind that the questions tend to change according to the requirements.
Record Accurate Information
Train your staff rigorously to take extra care while transcribing information into patient records. This information creates a strong base of the medical claim. Even the slightest error can create a difference between a clean claim and a denied claim. Rushing through insurance verification practices and making data errors will cause weeks of delay in payment reimbursement. There is a high chance that your claim can go unpaid, which is obviously very bad news for any medical practice.
Regular Follow-Ups with Patients
If you have any query about patient information, you can take follow-ups from the patients about their insurance information. A patient portal is a pretty convenient way to inform patients about their eligibility through email or online communication. However, the office staff can also connect with patients over call and let them know about their copays or any other issues. Informing the patients about their out-of-pocket expense increases the chances of collecting the pending payments.
Outsource with Professional Partners
Insurance verification is very important for practices if they don’t want to get stuck in the loop of denials. Though it is quite understandable that not every healthcare provider will have the expertise of insurance verification its importance cannot be neglected.
Under these circumstances it is advisable to partner with medical billing professionals like Unify Healthcare Services who have immense expertise in the field.
Unify Healthcare Services is a well-regarded medical billing and coding company. We have a team of trained professionals who are well versed in all the elements of medical billing. Our experts can take care of all your medical billing documentation requirements along with insurance verification.
Unify healthcare takes a huge load from your shoulders and ensures that all the claims submitted are accurate for faster and precise reimbursement. Our trained team is well versed with all the coding and billing guidelines and are always updated about the latest changes in the field.
We envision making billing easy and efficient for every healthcare practice so providers can treat the patients with peace of mind. This improves the footfall which ultimately increases your revenue.
