Obtaining insurance verifications is the most critical step in the medical billing process. Recent reports indicate that 30-40% of claim denials occur because of patient eligibility problems. Pre-authorizations (a process used by health insurers to determine whether a prescribed procedure, service or medication is covered) are also critical to manage patient care efficiently. However, pre-authorizations are a costly, resource consuming and frustrating process for physicians. Each of these front desk responsibilities are full of challenges and can have a direct impact on a practice's bottom line.
Steps for Tackling Patient Eligibility Challenges
First off, practices should obtain new and updated insurance information from every patient. Although you can obtain this information by phone, having a copy of the patient's insurance card can prevent inaccuracies, such as misspelling of the patient's name, incorrect ID numbers, date of birth, wrong subscriber information, and more.
So now that you have all of the correct insurance information, what's next? You'll need to confirm that the patient's policy is active and verify all the specific details. Many practices rely on those quick click insurance verifications (that you can find with some insurance portals, EMRs, and practice management software); they often fall short of their objectives as they contain limited and sometimes outdated information.
Ideally, insurance carriers should be called directly for all patients before the scheduled visit. Unfortunately, this can be a very grueling process that involves a lot of time and effort. Frequent insurance changes coupled with extended hold times make this a difficult task to manage, and it often has a negative impact on the patient experience and level of care. Having a dedicated staff member or insurance verification service to provide accurate and comprehensive insurance verification is a much better option and can also improve overall patient satisfaction.
Implementing a workable administrative process is crucial because incomplete or inaccurate information about the patient's coverage can cause carriers to deny claims. Many factors related to insurance coverage can change over a short period of time. For instance, things like the birth or adoption of a child, change of job, or marital status, etc., can impact coverage. The insurance verification process should be customized for every practice and should include all primary, secondary, and tertiary coverage. It should include information such as copayments, deductibles, coinsurance, exclusions, lifetime maximums, claim mailing address, and more. It should also include detailed benefit information on specific procedures or tests and whether a pre-authorization is required.
Another integral part of the insurance verification process is documenting the patient's out-of-pocket costs. Deductibles are rising, which is causing medical costs to shift toward the patient's responsibility. Industry research shows that more than 80% of self-pay bills are never collected, and more than 50% of patient responsibility, after insurance, ends up as bad debt. Billing a patient after the point of service not only reduces the physician's chances of getting paid, but can also have a negative impact on patient satisfaction. Patients often become very frustrated and angry when presented with surprise medical bills. Looking to have this process taken care of for you? Reach out to us at Horizon Revenue Solutions, we help private medical practices from San Jose to Sacramento. Our phone number is (408) 444-8845 and we'd be happy to get you in contact with one of our medical revenue account managers.