Medical practices face several challenges that can hinder efficiency and impact revenue cycles. One aspect that the front office often has problems handling is checking patients’ insurance coverage. While a patient’s insurance coverage may seem straightforward, not checking details can create billing complications. Insurance verification services play a vital role in this context by ensuring smooth billing processes for patients and proper compensation for healthcare providers.
The key health insurance-related issues that medical practices face range from inaccurate patient information, intricate insurance policies and procedures, changes in coverage, meeting prior authorization requirements, and time-consuming administrative tasks to compliance with privacy and security regulations and managing uninsured or underinsured patients. When it comes to managing these aspects, outsourcing preauths and insurance verification to experts is a game changer. This will ensure that all coverage details are checked before the patient visit, promoting a smooth billing and claims submission process. Let’s see how this works.
Advantages of Outsourcing Insurance Verification
The process of verifying health insurance eligibility involves accurately recording personal information about the patient and their insurance coverage. This includes contacting the insurance provider, confirming the policy details, and obtaining any necessary pre-authorizations. Additionally, it involves following up with the patient as required, updating the billing system, and ensuring that the insurer meets their obligations specified in the policy.
To carry out this verification, numerous patient details must be checked. These include the patient’s name, date of birth, social security number, address, the name of their insurance carrier, the type of plan they have, the specifics of their coverage, the status of their policy, the effective date of the policy, any exclusions or limitations, the benefits that are payable, as well as information regarding co-insurance, co-pays, and deductibles. Other aspects that need verification include pre-authorizations and referrals, health insurance caps, the type of Medicare coverage, coverage for durable medical equipment (DME), and out-of-network benefits.
Outsourcing this verification process offers several advantages for healthcare providers:
Reduced Claim Rejections
Professional insurance verification specialists have the expertise needed to identify crucial details when determining insurance coverage. With their extensive experience in handling numerous verifications, they have a proper understanding of what falls within the scope of coverage and what does not. By leveraging advanced technology and dedicated teams, these experts optimize the verification process, minimizing risk of errors or omissions. This precision leads to the submission of cleaner claims to insurers, dramatically minimizing the risk of errors that can lead to claim rejection.
Hassle-free Prior Authorization (PA) Process
Prior authorization issues are associated with 92 percent of care delays and may contribute to patient safety concerns as well as administrative inefficiencies, according to a survey from AMA. It was found that physicians and their staff spend an average of almost two business days (14 hours) each week completing PAs. Up to 88% of physicians surveyed described the burden associated with PA as high or extremely high. Though insurers ultimately authorize most requests, the process can be lengthy, resulting in recurring paperwork, multiple phone calls, and administrative hassles, all of which can delay or disrupt a patient’s access to vital care.
Outsourcing preauths to experts in this field can reduce denials. It will ensure all patients minimize denials by ensuring that all patients seeking network or out-of-network care, advanced diagnostic tests, or elective procedures have appropriate pre-authorizations documented on file. Outsourcing relieves practices of the administrative burden, minimize data errors, reduce denials, save time and money, and improve patient care.
Cost Savings
Outsourcing patient eligibility verification offers medical practices substantial cost savings by saving the costs associated with in-house staff, training, and infrastructure. Outsourcing companies usually operate in geographical locations with lower labor costs, offering a cost-effective alternative to internal handling of the process. Professional service providers leverage advanced technologies and streamlined methods, resulting in improved efficiency and reduced errors during verification. Their scalability enables healthcare providers to adapt to fluctuating workloads, optimizing resource allocation and further enhancing cost-effectiveness. By outsourcing this task, healthcare providers can redirect their focus and resources towards core activities, leading to significant long-term financial benefits.
Access to Expertise
Expert insurance verification companies stay current with evolving industry regulations and compliance standards. These experts guarantee precise verification of patient insurance information, including policy details and coverage limitations. Access to a pool of specialized professionals enhances the efficiency and accuracy of the verification process, resulting in a smoother and compliant insurance workflow and streamlined claims process, reducing the risk of claim rejections.
Enhanced Patient Experience
The ultimate goal of healthcare providers is to deliver a better patient experience. Negative experiences with the billing, unforeseen last-minute procedures, and huge medical bills can ruin the entire patient experience. Often, patients can be left with inaccurate details about the cost of treatment and out-of-pocket expenses, leading to surprise bills.
“A significant number of the clients who contact us are employees experiencing severe burnout from managing an excessive number of additional office responsibilities. When their actual job is mainly patient care, unfortunately, tasks such as preauths and verifying insurance often fall on their shoulders due to the staffing shortages or lack of experienced additional staff available to assist. Outsourcing those tasks makes for a less burdened/stressed out in-house staff. Happier employees, better patient care,” says Natalie Tornese CPC, OSI’s Director of Revenue Cycle Management, Healthcare Division.
Outsourcing can ensure faster and more accurate processes, contributing to a smoother patient experience. Reduced delays in processing insurance claims can lead to quicker billing cycles and resolution of payment issues, enhancing overall patient satisfaction.
Improved Revenue Cycle Management
Outsourcing patient eligibility checks ensures an efficient and prompt verification process, significantly reducing the potential for claim denials caused by inaccurate or incomplete insurance information. This translates into faster reimbursement cycles, ultimately improving cash flow for healthcare providers. By determining patient financial responsibilities upfront, healthcare providers can promptly collect payments, further enhancing their cash flow. Service providers utilize advanced technologies and specialized expertise which minimizes errors and enhances overall revenue integrity.
Risk Mitigation
Insurance verification specialists have comprehensive knowledge and expertise in navigating complex insurance landscapes. They remain up-to-date with the latest healthcare regulations and compliance requirements, minimizing the likelihood of errors and ensuring that verification processes adhere to industry standards. Their proficiency in staying abreast of evolving guidelines and regulations helps maintain accuracy and compliance throughout the verification process.
Partnering with an expert insurance verification company comes with numerous strategic advantages. These specialized firms possess extensive industry expertise and have a comprehensive understanding of complex health insurance protocols and regulations. They ensure that client medical facilities have essential patient benefit information well in advance of the patient visit. By leveraging their expertise, healthcare providers can optimize the precision and speed of insurance verification processes, thereby minimizing the likelihood of claim denials and delays. This proactive approach also ensures that patients are fully informed about their out-of-pocket expenses, mitigating the occurrence of unexpected bills and thereby elevating patient satisfaction levels.
Ensure seamless patient eligibility verification for your medical practice!
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.