Eligibility Verification Process is crucial in healthcare revenue cycle management. Physicians are responsible for eligibility verification of a patient, every time whenever appointment is scheduled.
Importance of Insurance Eligibility Verification
Insurance verification is the process of verifying a patient’s insurance in terms of coverage status, status of policy whether active or inactive, eligibility status. This process is very important as it directly affect to the claim status or delay in payment from insurance of a healthcare practice. Physicians can face such problems if eligibility verification is not performed correctly.
According to many surveys conducted in healthcare industry shows that two of the top five claim denial reasons were insurance coverage related.
Under HIPAA, Health and Human Services (HHS) implemented standards for electronic transactions, including the health plan eligibility verification.
Ways to make Eligibility Verification Process Faster
The HIPAA Eligibility Transaction System (HETS) is intended to allow the issue of eligibility data to Medicare Providers, Suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining Beneficiary liability or determining eligibility for specific services.
Copy of Patient’s Insurance Card
Physicians front end staff should be informed to take copy of patient’s insurance card for each date of service. This updated copy of both sides of insurance card in your EHR system can help billing team to verify typing mistakes of name or insurance details in CMS1500 claim form.
Get the Information from Insurance Provider
Insurance Eligibility Verification process can be carried out via a phone call to the respected insurance company, via insurance company website (payer or EDI) or medical billing software. Nowadays, many medical billing software has insurance eligibility verification process functionality.
Verify below listed patient information from Insurance:
- Co-Pays
- Co-insurances
- Payable benefits
- Deductibles
- Policy effective date
- Type of plan and coverage information
- Exclusions if any
- Mailing address
- Referrals and Pre-Authorizations
Many times, physicians verify insurance eligibility of patient for primary insurance. It’s necessary to verify patients’ coverage on all primary and secondary payers.
Update EHR / Medical Billing Software
Physicians or Hospitals should have trained staff to take extra effort while capturing patient’s insurance card details into medical billing software. This information can build foundation of medical billing claim. Do not rush while conducting verification process, this can avoid data errors which might cause of denial of claims and delay in payments or the claims are not paid by insurance company.
Contact Patient if required
Once you get the all information from the insurance company you can contact patient to make him aware about his eligibility. If there is any concerns or questions while doing eligibility verification process, contact the patient and get the answers as soon as possible to avoid delay. Informing patient about out-of-pocket expenses can increase the opportunity to collect patient responsibility amount at the time of appoint itself.
Medisys Data Solutions has been offering Insurance Eligibility Verification services to its clients. This service offered as a part of complete revenue cycle management. If you are looking only for Insurance Eligibility Verification service then you can connect with our medical billing manager. You can expect increase in cash flow, increase in error free claims, and ultimately patient satisfaction.
