One-Stop Solution For Revenue Cycle Management Services

salient steps of insurance verification

Unwinding the Salient Steps of Insurance Verification

Contacting the payer company to confirm the benefits coverage of your patients and determine whether the company meets all requirements for the treatments that you will be providing is the first step in the complete process of verifying patients’ insurance.

The deductibles, policy plans, included exclusions, and other specific demands in the plan that may affect expenditures and coverage benefits are the key points to note during this process. To ensure that you receive this assurance, you must finish this process well ahead of your patients’ sessions. This will allow you to validate the requirements and individual duties, which strongly implies that this will be your first approach to medical billing procedures.

The impact when you fail to do this verification to the fullest will be either to the patient or to you. For your side, it can be denied or reduced payments, for patients it will be a sudden notification for extra money payment. 

Giving your best effort while learning the majority of the procedure is the ideal solution, so come find more on this process:

Arguments put forth for claims denial

Could a simple health insurance verification put you through so much hardship? However, these are the payer’s justifications for repeatedly rejecting your claims. Services for eligibility and benefits verification services are denied as a result of:

  • Inadequate patient data
  • Blunders in claims
  • The policy that is expired
  • Different plan and coverage specifications
  • End of date of the plan
  • Irrelevant patient data

Missing these details will result in some common reasons for problems which are, denials, reworks, and payment delays which can cost patients and providers as said before.

Reasons to review this confirmation on health insurance?

There are multiple purposes, including avoiding reworks brought on by claims denials or unpaid cost of treatment, to give insurance verification as the priority.

More importantly, no need of wasting time on these claims rather than focusing on patients.

One way solution to this will be checking insurance eligibility that can give rewards in the name of dollars and stable work safety in the form of guaranteed cash payments.

What’s your next duty as a provider?

The Healthcare RCM cycle needs to be efficient, so every step requires attention, eliminating your weak spots is a healthy plan to have. Having the right partner who can accomplish this task easily will help you to achieve this.

Your next difficulty must be to identify the right partner. Here are some insights into the task that will be undertaken by your partner.

  • Will enable a smooth and straightforward work efficiency
  • Guide you throughout by being responsive
  • Makes cash flow to be steady
  • Reduce the burden on your in-office staff
  • Work in adherence to HIPAA guidelines and regulations

When you look back on them, you’ll see that they were worth the money you spent. To experience this you need the right partner, we are here to give this altogether services and more by just a call, contact Practolytics to know more about the services.

A list of essential steps

There is always a hidden solution available when there is a problem. You are fortunate to have not one, but four steps that secure your income for multiple months.

Health insurance verification with the help of these four-way steps can give you benefits coverage as a whole.

  • Acquiring the schedules of patients from hospitals
  • Confirming the range of coverage with the health insurance provider
  • Getting in touch with patients, to reach out for more information
  • Making sure the billing system is kept updated on every detail of the patients and their insurance plan.

Let’s move on, identifying the exact work procedures for each of the points enlisted above more deeply.

  1. Enrolling the patient

Your only duty in this entire process will be fully furnishing the data and staying active at your work, this will be the very first task that will be on your to-do list. When you’re having an outsourcing partner for eligibility and benefits verification services, just give them the patient data and other insurance information clearly so that they can further proceed. You will act more like a starting key to a bike where your partner will accelerate the cycle more quickly with their experts.

  1. Eligibility Checking 

When you outsource eligibility and benefits verification services, the result would be your easy checking procedure. Keeping in mind that most of the denials are due to inadequate data, your outsourcing organization must have the updated insurance data of your patients, which will be done with the help of their insurance provider.

They should meet the requirements of both primary and secondary payers by cross-checking with them. As your outsourcing expert gives you the exact details of benefits and payment coverages you can notify the patients well before their visit.

  1. Making follow-ups more convenient

Be it in healthcare RCM, or for treatments maintaining the time is always very appreciable. Even your doubts must not stop you from completing your tasks. Follow-up with patients is the option for you, but not by your regular calls, with automation it will be done in minutes. 

Patients can get instant notifications and emails or messages of their plan coverages and their out-of-pocket expenses with this facility and you won’t miss any of your patients as well.

  1. Updating up-to-date info’s in the system

A well-managed health insurance verification completes with ensuring that all the data is being uploaded in the billing system, and your revenue cycle partner will make sure every benefits charges are recorded promptly.

Concluding thoughts

Health insurance Verification is done before the patient visit helps you to prevent revenue shortfall or unlock the cash flow pathway for you. But what is very interesting is that nearly 30 percent of the income of providers is being spent on health insurance verification. This shows how many providers are not giving importance to this favorable service of both providers and patients.

That’s why you should outsource eligibility and benefits verification services, do contact Practolytics to know more on how we perform these essential works to the fullest.


ALSO READResolving Your Ongoing Insurance Eligibility Denials Headaches