Verifying Patient and Insurance Data

Need for Verifying Patient and Insurance Data

Patient and insurance data verification is crucial step in revenue cycle management of any medical practice. Insurance verification confirms your patient’s coverage and benefits, whereas insurance authorization gives you a green light to provide certain services. The insurance verification process involves collecting patient insurance information and verifying it with the insurer. Patient and Insurance data verification maximizes reimbursements, minimizes denied claims and keeps patients happy. Imagine a billing scenario where you had a great encounter with a patient and feel good that you’ve provided a satisfactory patient experience. That excitement can come crashing down if you find out your patient’s insurance information was inaccurate and your claims were denied. Proper patient and insurance verification before a patient encounter can avoid this undesirable outcome.

Patient and Insurance Data Verification Process

Patient and insurance data verification process is divided into 3 steps, discussed below:

Collecting information

Front desk team will collect patient and insurance information during intake and registration. Patient intake or registration has patient and insurance information section sections, ensure that you ask for all the required information. For an example, ask if patient has secondary insurance, if yes, ask insurance details for the secondary insurance. Collecting patient insurance information at intake means more than asking the patient which company insures them. It also means getting the patient’s insurance ID, policy number and, if applicable, group number.

The patient’s insurance card should also have a phone number that providers can call. You should record this number too. You should also check whether the patient or someone else is the policyholder. Make sure to record the policyholder’s full name and relationship to the patient. Group all the insurance information you’ve collected with the patient’s full name and date of birth, and you’ll have everything you need to proceed with further steps.

Calling patient’s insurance

Whether you have an excellent relationship with the patient’s insurer or have literally never worked with them before, contact them once you have the patient’s information. Contacting them over a phone is the best choice. Call the insurance provider number you collected from the patient and wait for a representative to answer. If you find yourself waiting for what feels like forever, call back later, as insurance provider lines are often quite busy.

Once you reach an insurance rep, verify that the person with whom you’re speaking is authorized to confirm a patient’s insurance details. Next, confirm with the rep that your current phone conversation is a HIPAA-compliant way to transmit patient information. Then, share the insurance information you’ve collected from the patient.  Alternatively, many insurers have online portals in which you can enter the patient’s data to verify their coverage and benefits. However, these portals have a reputation for being outdated, so the results of your verification could be inaccurate. Phone calls are thus generally best for insurance verification, but online portals can be a decent option.

Asking correct questions

With an insurance rep on the phone and your patient’s insurance information handy, you’re ready to learn the ins and outs of your patient’s coverage and benefits. To start, ask the rep to confirm all the information you’ve gathered. Then, ask whether the policy is active and when it expires. Assuming the policy is indeed active, you should ask the insurer what the patient’s co-pay will be. You should also collect information on the patient’s deductible.

The three steps above comprise the entirety of the insurance verification process. However, patients can theoretically lose insurance or switch plans at any time. It’s best to collect the patient’s insurance information before each and every planned visit.  Don’t just ask whether the patient’s insurance has changed, as this question doesn’t tell the patient the date of your most recent data on them. Instead, show them all the information you have and ask whether it’s correct or needs updating. If the information you show the patient is correct, then your insurance verification process is complete.

As discussed above, patient and insurance data verification is crucial step in revenue cycle management of any medical practice. But conducting patient and insurance data verification for every patient visit is time consuming process, requiring full time employee. Medisys Data Solutions can assist you in patient and insurance data verification along taking approval with prior authorization request. To know more about our eligibility and benefits verification services, contact us at info@medisysdata.com / 302-261-9187