Insurance verification is an essential part of the health care revenue cycle. Before delivering services, health care facilities have to check the status of insurance, type of covered services, and possible patient payments. The correct implementation of insurance verification will enable providers to avoid possible billing issues, minimize claim denials, and understand the possible patient’s financial liability.
The process of insurance verification becomes complicated for many health care organizations in the USA. It is true particularly for facilities that treat a lot of patients and/or work with many insurance companies. That is why many health care providers prefer outsourcing this process.
What Is Insurance Verification?
Insurance verification is a process by which the insurance information of a patient is verified prior to any medical consultation or procedure.
The following aspects may be reviewed by a verification team:
- Name of the patient
- Date of birth of the patient
- Policy Number of Insurance
- Group and Member numbers
- Policy Status
- Effective Date of Coverage
- Deductible and Copay
- Coinsurance
- Maximum out of pocket expenses
- Requirement of Referrals
- Requirement of Prior Authorization
- Covered Services
- And many more.
Why Is Insurance Verification Important?
An incorrect or incomplete insurance coverage can cause difficulties for both provider and client. In case when treatment is given before verifying the patient’s insurance coverage, the treatment is denied by the insurance company at some point in time.
Verification allows identifying any problems that could occur with the insurance. The patient’s insurance coverage might be expired, the provider could be out-of-network or some services could need prior approval.
Verification allows the provider dealing with these questions before the treatment.
The process will increase patients’ satisfaction. It is easier for a patient to know what amount of money he/she should pay before starting any procedure.
Why Do US Providers Outsource Insurance Verification?
Healthcare offices have other tasks apart from verifying insurance information. The personnel have to take care of booking appointments, communication with patients, documentation, billing, and many others. Overburdening the internal team with the task of verification would mean extra work for them.
Delegation of the task to a third party helps the office to entrust the tedious task to experts.
An expert team can handle various insurance networks according to a set procedure of verification.
Benefits of Outsourcing
Firstly, time savings can be achieved through outsourcing. Rather than spending numerous hours verifying the insurance information, internal employees would be able to utilize their time on something else.
Accuracy is another potential benefit of outsourcing. Professionals specializing in verification use certain procedures for reviewing the information related to patients and their insurance.
Furthermore, outsourcing could lead to improved revenue cycle management since by identifying any coverage problems prior to providing services, one could minimize unnecessary claims denial.
Outsourcing could also help with scaling up/down verification services. It means that a healthcare practice could manage the number of verification services depending on the number of patients.
How the Process Usually Works
Typically, it starts with the provision of patient and appointment information by the provider to the verification department. The verification department will then verify the insurance information for the patient using the resources available for payers. This information will be recorded after confirmation of both coverage and benefits information. Any problem encountered can be communicated to the provider to ensure that action is taken.
This information should be captured effectively for use by the billing and administration departments.
Choosing the Right Outsourcing Partner
Healthcare providers need to seek out a service provider who has expertise in the healthcare process in the US and insurance validation. Security of data, accuracy of the process, turn-around time, communication skills, and payer requirements knowledge are critical considerations.
There is a need for an established quality assurance process as well.
Final Thoughts
Verifying insurance is just one of those administrative duties that are often overlooked; however, this is one of the processes which is critical for effective functioning of healthcare institutions. Verifying the patient’s insurance cover prior to treatment can help prevent any billing complications, facilitate better communication with patients, and contribute to effective revenue cycle management. Incinque Business Solutions is a good solution for healthcare organizations in the USA.
