Eligibility verification is a crucial step in the revenue management cycle, and oversights and errors in verification can result in considerable loss of revenue for healthcare entities. Outsource Strategies International’s (OSI) expertise in providing eligibility verification services ensures a smooth billing process for practices of all sizes and specialties. A leading medical billing company in the healthcare BPO outsourcing space, OSI verifies each patient’s insurance benefits and coverage for specific medical procedures so that its clients do not experience claim denials and delays.
The Client – Utah-based Medical Billing Company
The client is a medical billing company from Holladay, Utah who was looking for cost-effective, accurate and timely insurance verification services. The company is the billing partner for a retina ophthalmology practice, the largest in southeast Texas that specializes in medical and surgical management of diseases of the retina. It aimed at ensuring that physicians earned more, and faster without compromising on patient satisfaction in any manner. So, what was their challenge? They were finding the insurance verification process, an important step in the medical billing cycle rather time-consuming and resource draining. They didn’t want to hire staff just for this task. They had tried outsourcing to an external agency which proved unsatisfactory. To handle the challenge they approached OSI.
Handling the Challenge the OSI Way
OSI has an amazing medical billing and coding team, so they could rise up to the occasion and perform efficiently. Based on the requirement, a small trial was given with which the client was satisfied though concerns remained regarding the sheer volume required – 400 verifications per day. There were no issues in meeting the requirement during the live trial that ran for 3 days. During the trial period, services verified included procedures such as intravitreal injections, ocular trauma repair, laser treatment of the retina, pneumatic retinopexy, sclera buckle, vitrectomy and secondary intra-ocular lens implants including scleral and iris fixation of intraocular lens implant. Following the trial that met with their satisfaction, the client was confident enough to hand over the verification responsibility to OSI. OSI also implemented 5 FTE and a QA manager for handling the project. With the effort taken by the team, the client was really happy and has been with OSI for around a year.
Results that Please the Client
- The OSI team maintains 98% accuracy for all the verifications.
- Verification for procedures is handled 2 weeks in advance, while also handling add-ons.
- They successfully meet the client’s volume requirements
- Verification calls are recorded, which is a good strategy since it helps provide valuable backup.