Why Healthcare Practitioners should Outsource Medical Insurance Verification

by Outsource Strategies International Medical Billing Company

Healthcare practitioners and their staff have more important things to do than extensive paperwork. Physicians are on call all the time, have a large number of patients to attend to, and need to be ready to perform lifesaving tasks at short notice. It can be quite demanding for physicians to handle extensive non-core responsibilities such as medical insurance verification within their practice. It would consume their time and resources and also result in a greater chance of errors in the process.

Medical Insurance Verification Must be Error-free

Proper eligibility verification as well as accurate medical billing and coding are necessary for the submission of a complete and error-free medical claim. Any errors in these processes would results in delayed or rejected claims. It must be ensured that the patient is eligible for the services billed by the healthcare provider. A professional medical billing company would provide the following services as part of medical insurance verification:
•    Receive patient schedules from the healthcare provider’s office via fax, email or other means
•    Verification of coverage on all primary and secondary payers
•    Contacting the patient for information if needed
•    Verify member ID, group ID, coverage end and start dates, co-pay information and much more

The expert team in the medical billing company will review the health insurer’s contract to determine their rules regarding pre-authorization, pre-certification and/or pre-determination. This is done to ensure that the physician practice fulfills the conditions of the health insurer’s verification of a patient’s coverage for benefits.

Health insurers usually ask for pre-authorizations for specific in-office and/or outpatient diagnostic tests and surgical procedures. This is to is to establish that the physician had provided services in accordance with the health insurer’s medical necessity guidelines.

Pre-determination of a patient’s benefits is done by submitting the required information to request in advance the determination of a patient’s coverage for a particular service or procedure. Health insurers generally specify the procedures which need to be verified in advance. Ensuring that patients are eligible for services before services are provided reduces the need to rework claims and also alerts caregivers and patients about issues if any and their options. A reliable service provider will undertake to send the pre-determination letter to the insurance company with all the necessary information.

Benefits of Outsourced Insurance Eligibility Verification

The key in insurance eligibility verification is to get the confirmation that the patient is covered under a relevant and up-to-date insurance plan before commencing treatment. Outsourced insurance verification services can ensure physicians the following benefits:

•    Reduced rejections and denials of claims
•    More time for patient care
•    Greater patient satisfaction
•    More clean claims
•    Greater collection of upfront
•    Greater cash inflow
•    Greater profit
•    No more eligibility verification backlogs
•    Improved efficiency in the healthcare facility
•    Reduced costs – operational cost savings of up to 40%

A reliable medical billing company can provide comprehensive medical insurance verification services to meet the needs of various kinds of healthcare facilities.