Be Proactive about Patient Collections with Insurance Eligibility Verification

by | Last updated Dec 8, 2023 | Published on Nov 22, 2016 | Insurance Verification and Authorizations

Insurance Eligibility
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The increasing adoption of high-deductible health plans (HDHPs) with rising out-of-pocket costs has changed the medical landscape as patients’ ability to meet their responsibility is falling. In the current scenario, physicians need to revamp their collections process with strategies like insurance eligibility verification to manage their operational expenses and remain viable.

With HDHP’s, the consumer is responsible for a large portion of the service. While HDHPs give the consumer greater flexibility in handling their healthcare expenses, rising out-of-pocket costs is affecting their ability to pay, say recent reports. This has directly affected the finances of healthcare practices.

In June 2016, Modern Healthcare reported on the findings of TransUnion Healthcare, the healthcare revenue cycle management arm of credit rating firm TransUnion. According to the report:

  • Revolving credit that consumers had to cover every $100 in medical costs fell from $2,250 in the first quarter of 2015 to $1,720 in the first quarter of 2016
  • Highest-risk patients had just $420 in revolving credit for every $100 in medical costs in even the first quarter of 2016
  • Between 2014 and 2015, patients saw a 13% increase in both deductible and out-of-pocket maximum costs with a total average annual deductible of $1,278 and total average annual out-of-pocket costs of $3,470

This has serious implications for both patients and healthcare providers. Modern Healthcare reported that some providers are even filing debt collection lawsuits against patients.

The primary goal of any physician is to provide quality care. In the present context, medical practices need to rethink the way they handle patient flow if they want to remain financially stable.

What are the procedures that medical practices must put into place to ensure a greater chance of receiving payment? Many are turning to experienced medical billing companies for solutions. In fact, reliable companies offer a comprehensive range of services designed to help physicians maximize collections, starting from point-of-service collections.

The process begins with insurance eligibility verification. This involves obtaining the patient’s insurance information before the appointment, usually over the phone when the visit is scheduled or during a reminder call. The insurance verification specialist will verify details such as payable benefits, co-pays, co-insurances, deductibles, patient policy status, effective date, type of plan and coverage details, plan exclusions, referrals and pre-authorizations, life time maximum, and claims mailing address and so on.

Verifying such information is crucial to get a clear idea about the patient’s responsibility and initiate steps to collect payment.

  • When the patient arrives or after the physician completes the diagnosis, the practice can immediately begin a conversation about the patient’s out-of-pocket costs.
  • If the visit is a planned one, patients can be informed about the payment before they come to the office for their appointment so that they can bring their payment with them.
  • Reliable medical billing service providers ensure that all the necessary billing data is available and accessible so that physicians can estimate what a patient owes at the time of service.
  • Practices must be prepared for patients who cannot pay. They can offer such patients convenient plans to collect payments in installments till the balance is paid off.

With the change in government, the future of the Affordable Care Act is uncertain. Nevertheless, as people continue to enroll in the health insurance exchange for coverage in 2017, medical practices need to have proactive policies in place to manage collections.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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