Verifying healthcare insurance is the bane of primary care providers everywhere, sucking up time and valuable resources from both the front and back office staff. You’ve probably given more than passing thought to the irritations involved in the process, but you probably haven’t considered the impact on your bottom line.
Verifying healthcare insurance should be one of the first steps performed once you obtain the patient’s demographics. You most certainly need to verify insurance benefits before the patient arrives to your practice. Knowing if their plan is active, and if you are going to get paid for the care provided is critical. Basic information like co-pay, deductibles, and co-insurance are the essentials needed to see the patient. But what if you want to know about reimbursement for an MRI or OCT? Do you know if the procedures are covered by their insurance? Is there a routine vision benefit under their medical insurance plan? Do you know what you are required to collect financially from the patient at the checkout?
Verification of your patient’s healthcare insurance is not just a way to determine if you are going to get paid, it is good customer service. It is a great way to educate your patients on what their insurance covers. Each patient’s insurance needs to be verified each time they come into the office. Although it takes time, it is one of the most important responsibilities of the medical office staff.
Claims rejection happens due to any of the following reasons:
- The patient changed his or her insurance plan
- The service provided is a non-covered benefit
- The patient’s coverage is not active
- The service provided required pre-authorization
- The patient insurance is out of network coverage
Insurance verification is very vital to your practice to sustain a good revenue cycle, timely payment, maximized reimbursement and more cash flow. There are sophisticated verification tools available that automate much of the process, but if you follow the basic protocol, you’ll help to ensure timely payment for your services.