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Importance of Checking Patient’s Eligibility and Benefits with the Evolvement of Multiple Insurance Sub Plans

Providing medical care to your patients is your top priority, as it should be. But there are many technical things you need to consider as they all play an important role in patient care and patient satisfaction rates. Your practice has to be transparent not only in the quality of care provided but also in the costs and the insurance aspect of it all.

Not all of your patients will be insured or even aware of the eligibility of their own insurance plan, which may mean that they are not covered for their appointment at your service. And that is okay as long as you have verified that information before the appointment and not after. This will give you the chance to calculate patient costs before the appointment so that the patient is aware of how much the visit will cost them.

In general, healthcare providers spend approximately 12.64 minutes checking patients’ insurance plans and verifying their eligibility. This may seem like a long time and you may be tempted to avoid it at the moment, and just deal with it later but that is not recommended.

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The consequences of not verifying eligibility often lead to increased costs for the patient and you, which the patient may not be aware of, hence, resulting in a disgruntled and unhappy patient. Not just that, there is a high likelihood that this will result in unpaid claims which eventually end up costing the service. You cannot provide proper patient care and care for your service without ensuring that this aspect of the appointment is also covered.

How to Verify Patient’s Insurance?

To verify your patient’s insurance claim, you have to cross reference the insurance information provided by the patient with the insurance provider to ensure that the patient’s policy is active and whether the patitent is eligible for the service. This is all that you need to do and if the data provided is accurate, the insurance verification process is complete.                                                      

It is important to note that verification of patient insurance does not in any way mean that the insurance provider has to fund the visit. To guarantee the funding of the visit, the insurance provider has to authorize the claim which can only be done once the insurance payer has signed a legally binding document specifying the set amount to be paid.

These two steps make the payment process easy and clear for all parties involved. The patient is now aware of what they need to pay and the service is less likely to end up with an unhappy patient and an unpaid claim.

The Benefits of Patient Insurance Verification

The benefits of patient insurance verification are mostly avoiding the consequences of not verifying the patient’s eligibility. The 12.64 minutes that it will take you in general, will save you a lot in time, effort, and finances, eventually.

Minimizes Denials and Increases Reimbursements

Insurance fraud is at an all-time high which means that insurance providers review each claim with increased scrutiny. Lack of patient insurance verification may make you prone to denials from the insurance either because the patient isn’t covered or the information provided isn’t accurate. These denials mean that the claim submitted by you is not going to get paid which can be detrimental for the finances of your service.

However, if you have verified all information prior to the visit and gotten pre-authorizations, then insurance providers have no reason to deny the claim. This significantly increases your chances of reimbursements which are always good for business. Spend less than 15 minutes in your patient files and let the worry of denials leave your mind completely.

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ALSO READ: 12 Things A Practice Must Do To Maximize Reimbursements

Smoother Clinical Practices

The most common complaint that people have when they go for a doctor’s appointment is that they have to wait for a long time, despite having a set appointment time. One of the reasons your service may be lagging behind is that you are verifying patient’s information and dealing with any faults in the information provided by the patient at the time of the appointment. Verification and eligibility checks should be performed prior to the appointment, preferably a day before to make sure that the clinic runs smoothly the next day.

Even 10 minutes per patient adds up to a lot by the end of the day and can result in the last patient being delayed for a much longer period of time than acceptable. Your patients should receive the highest quality of care and in a timely fashion. This is why it is recommended to verify insurance details the day before and not on the day of the appointment.  We, at Practolytics verify all patient eligibilities at least 24 to 48 hours prior to the visit and ensure the practice is aware of what to collect from the patient at the time of the visit.

Better Patient-Doctor Relations and Easier Point-of-Service Collections

When you verify the patient’s insurance information prior to the appointment, it does not just help your service but also helps the patient because you are letting the patient know beforehand that the insurance might not accept this visit or they may not have the insurance plan required for them to be eligible for the reimbursement of this visit. This way information is not just sprung upon your patient at the time of the appointment but rather given a day before so that the patient can choose the best option for themselves. The patient then knows what needs to be paid, and will appreciate the forward warning.

As most people do not understand much about insurance plans, they are not likely to know the coverage of their insurance plans either. This means that they, most probably, do not have the required funds at the time of the appointment. This will result in several unpaid revenues for your service. Moreover, your patients will also appreciate the transparency of your service and how easy the whole process is for them if you verify the information the day before. This guarantees an improved patient-doctor relationship in the future.

Connect with our team at Practolytics to understand how the entire process of eligibility verification works, and how we setup each patient visit in a timely manner in terms of patient eligibility and coverage benefits.


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