Why Outsource Insurance Verification and Authorization, a Key Step in Revenue Cycle Management?

by | Published on Jul 25, 2023 | Insurance Verification and Authorizations

Why Outsource Insurance Eligibility Verification and Authorization, a Key Step in Revenue Cycle Management
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Managing the revenue cycle in healthcare is a complex and challenging task that requires careful attention to detail and a deep understanding of the insurance industry. One crucial aspect of healthcare revenue cycle management (RCM) is insurance eligibility verification and authorization. These processes ensure that patients receive timely and appropriate treatments while minimizing financial risks for healthcare providers. However, managing these tasks in-house can be resource-intensive and time-consuming. That’s where outsourcing insurance verification and authorization becomes a game-changing strategy.

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Why Insurance Eligibility Verification and Authorization Is Important

Insurance eligibility verification involves confirming a patient’s insurance coverage to ensure they are eligible for the services they are seeking. Insurance authorization, on the other hand, entails obtaining approval from the patient’s insurance company for the proposed services.

The complexity of the insurance industry poses significant challenges for healthcare organizations when it comes to managing these processes in-house. One of the main hurdles is the intricate nature of insurance. Front office staff must have an in-depth understanding of the insurance industry and be familiar with the specific requirements of various insurance companies. Moreover, they need access to the right technology and tools to efficiently handle the process.

Another challenge stems from the constant changes occurring within the insurance industry. Insurance companies frequently update their policies and requirements, making it challenging for healthcare providers to keep up. Managing these changes internally can consume valuable time and resources. So, many healthcare providers turn to outsourcing. Professional medical billing outsourcing companies can ensure that this critical process is managed effectively and efficiently.

Here’s a video podcast from OSI’s President Rajeev Rajagopal, discussing why outsourcing insurance eligibility verification and authorization is an important part of healthcare revenue cycle management.

Benefits of Outsourcing Insurance Eligibility Verification and Authorization


  1. Cost-effectiveness: Maintaining an in-house team solely dedicated to insurance-related tasks can impose a financial burden. Recruiting, training, and retaining skilled staff, along with investing in necessary technology and software, can quickly accumulate costs. Outsourcing eliminates these overhead expenses. Reliable outsourcing providers offer flexible pricing models, enabling you to pay for services as needed. This cost-effective solution ensures that your resources are utilized efficiently.
  2. Access to expertise: Outsourcing the task allows you to tap into the expertise of specialized professionals. These dedicated teams have in-depth knowledge and experience in navigating the complexities of insurance plans, policies, and procedures. With services from experienced providers, you gain access to their industry-specific knowledge and ensure accurate and efficient processing of claims.
  3. Enhanced efficiency: Outsourcing frees up valuable time and resources within your organization. Instead of your staff juggling multiple responsibilities, they can focus on core tasks such as patient care and revenue generation. With a dedicated team handling the revenue cycle management process, you can streamline operations, reduce administrative burdens, and improve overall efficiency. This results in a faster and smoother revenue cycle, leading to improved cash flow and reduced claim denials.
  4. Scalability and flexibility: As your practice grows, the volume of insurance verifications and authorizations may increase. Medical billing outsourcing companies have the scalability to handle fluctuating workloads, ensuring prompt processing without compromising quality. Whether you need assistance during peak periods or ongoing support, outsourcing offers the flexibility to adapt to your changing needs. You can scale your operations seamlessly without the hassle of hiring and training additional staff.
  5. Compliance and accuracy: Insurance regulations and requirements are in a constant state of evolution. It can be challenging for in-house teams to stay updated and compliant with these changes. Professional providers specialize in insurance eligibility verification and authorization and possess a keen understanding of industry regulations. They are equipped with the latest knowledge and technology to ensure accurate verification, authorization, and claims processing, reducing the risk of errors, rejections, and compliance issues.

Outsourcing revenue cycle management tasks can also help healthcare providers maximize their revenue growth. By ensuring that they are billing accurately and appropriately, healthcare providers can increase their revenue and reduce their loss due to denied claims. Outsourcing also allows healthcare providers to focus on their core competencies and provide high-quality patient care, which can lead to increased patient satisfaction and loyalty.

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Natalie Tornese

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.

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