Insurance Verification Services - Its Importance

By Gerald Hawkins

For physicians, hospitals and healthcare institutions, who are in the business of saving lives, insurance benefit verification is a time consuming task. Insurance verification services are a crucial part of the medical billing process and play a major role in the healthcare provider's claims denial management program. Offered by professional medical billing companies, health insurance verification services help group and specialty practices and hospitals to check a patient's active coverage with the insurance company and verify whether the patient is eligible for scheduled medical procedures.

Eligibility verification process has to be carried out before the patient is admitted to a hospital. Services provided cover the verification of payable benefits, co-pays, co-insurances, deductibles, effective date, patient policy status, type of plan and coverage details, plan exclusions, claims mailing address, referrals and pre-authorizations, life time maximum, and more.

Insurance eligibility verification is a necessary step in the medical billing process. There are many reasons that make health insurance verification services a necessity. In order to avoid claim rejection, each healthcare provider has to verify the insurance eligibility and coverage benefits of the patients, before the patient is provided medical services. Or else, it might lead to problems such as delayed payments, increased errors, need for rework, non-payment of claims, patient dissatisfaction and more.

Non-verification of insurance eligibility would lead to problems such as delayed payments, rework, increased errors and patient dissatisfaction. All this underlines the importance of insurance verification in healthcare.

Insurance Verification Services for Speedy Reimbursement

Outsourcing insurance verification services would be a good option for health care professionals who do not have the time to spare on insurance benefit verification. The benefits of outsourcing medical insurance verification are:

• Faster billing cycles
• Speedy approval and authorization
• Simplified workflow
• Reduced risk
• Reduced number of returned claims
• Improved payment and collections

Health insurance verification specialists, called insurance verifiers, are assigned by the medical billing company to work closely with providers and patients. They will work with patients, complete paperwork, and verify patient information with the insurance carrier to maximize reimbursement and improve the revenue cycle. They will also carry out all follow-up processes, ensure that requirements are met and send back the results to the provider. They will also communicate with the insurance provider to communicate missing information, appeals, and other relevant things. The insurance eligibility verification process involves many steps:

• Receiving patient schedules from the hospital or clinics via FTP, email or fax
• Verifying patients' insurance coverage on all primary and secondary (if applicable) payers
• Verifying demographic information
• Updating patient accounts
• Contacting patients for additional information if necessary
• Updating the billing system with eligibility and benefits details such as member ID, group ID, coverage start and end dates, co-pay information

Insurance verification services and its importance in healthcare industry demand the involvement of professionals for a successful outcome.

Outsource Strategies International (OSI) offers medical billing services, focusing on every aspect of the medical billing / patient cycle. Our cutting edge HIPAA-compliant technologies, web based software, trained staff and strict quality control processes ensure timely and efficient medical billing service.

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