Aug 11, 2022

The Importance of Verifying Patient's Insurance in Medical Billing

Claim denied. These are two words that those who are involved in healthcare revenue cycles dread the most. But claim denials are quite common and eligibility issues are one of the top five reasons for it. In fact, as per an industrial research study, nearly 27% of the claim denials are due to registration and insurance eligibility issues. As insurance eligibility is directly linked with claim denials, the insurance details should be verified thoroughly even before the patient is admitted at the hospital and services are initiated. Well, if you are on the lookout for a simple strategy to reduce denials, checking eligibility is what you need to do.

What is insurance eligibility verification?

Insurance eligibility verification is the first and most crucial step in the revenue cycle management process. Verifying patients’ eligibility and benefits in advance is vital to preventing claim denials and financial bottlenecks. Well, what exactly is insurance eligibility verification? It is a process of confirming whether the patient has active insurance coverage in order to ensure that the insurance company will pay the amount the patient owes the doctor's office for their medical care. In some medical practices, the front office staff handles the insurance verification process while others choose to outsource.

When is the insurance verification process done?

Verification of eligibility and benefits should be done before any medical services or medical care is initiated in order to ensure that it is included in the patient’s health insurance coverage. Failure to carry out an effective insurance verification process can lead to delayed payments or claims denials, ultimately disrupting the cash flow of your practice.

Importance of insurance eligibility verification process

Insurance verification is an important, yet neglected step, whether you have been practicing for a while or are just starting out.

Reduces claim denials: A streamlined and accurate eligibility verification process helps to submit cleaner claims and reduces the need for any rework. Clean submissions also ensure that your payments are rendered promptly. So, to prevent denials never skip a detailed insurance verification process.

Improves patient experience: All of us have experienced a situation, where a medical service isn’t covered and we end up paying out of our own pockets. Verifying insurance prevents patients from financial burden arising from surprise billing, ultimately improving patient satisfaction. According to a report, 92% of patients want to know their financial responsibility upfront.

Optimizes cash flow: Verifying coverage in advance ensures the submission of cleaner claims that are quickly processed and accepted, resulting in better cash flow. It also reduces the chances of claim denials, rejections and bad debts. In short, better claim submissions and lesser claim denials helps maintain your practice’s cash flow.

Ensures efficient workflow: Accurate insurance verification helps to enhance the overall revenue cycle management process. A streamlined and efficient approach paves the way for a better patient experience, fewer claim denials and improved financial performance.

The 5 step insurance verification process

Collect a copy of the insurance card from the patient.
Gather critical information like patient name, name of the insured person, relationship to the patient, insurance ID, group number, relevant phone numbers, start and end date of the policy, and whether the insurance covers the procedure or service provided.
Get in touch with the insurance provider over the phone to confirm the eligibility.
Carefully record all relevant information gathered from the patient and the insurance provider as any errors can lead to denials.
Connect with the patient as and when needed to clarify any doubts.

Medical practices must carry out an insurance eligibility verification process to make sure that the services are covered. This process demands meticulous attention and medical practices do not have the time to perform it efficiently. Therefore, it is best to assign this task to a professional service provider like Scribe4Me. We have a team of insurance verification specialists on staff to carry out this crucial task and ensure a significant savings of 30% to 40% on your insurance verification operational costs. We literally work as an extension of your practice to verify insurance coverage, helping you save overhead costs and better focus on patient care without having to worry about denied claims and reimbursement issues.