Changing policies. New forms. Added steps to the process. Pick these, yet alone the longer laundry list of the problems related to eligibility reporting, and it’s understandable the reasons practices struggle with staying current and optimizing the tools available to them. I correlate it to taxes – tax accountants are paid to stay current with everything and thus maximize the return to each customer.
The same can be stated for physician eligibility verification. You will find specialists it is possible to outsource to, ultimately optimizing this process for that practice. For those who maintain the eligibility in-house, don’t overlook proven methods. Adhere to these pointers to aid assure you have it right every time and lower the risk of insurance claim issues and optimize your revenue.
Top Five Overlooked Methods Proven to Raise the Efficiency, Accuracy of Eligibility Verification.
1) Verifying existing and new patient eligibility every single visit: New and existing patients needs to have their eligibility verified Every. Single. Visit. Quite often, practices do not re-verify existing patient information because it’s assumed their qualifying information will stay the same. Not the case. Change of employment, change of www.datalinkms.com Datalink MS Medical Billing Solutions » Insurance Eligibility Verification, services and maximum benefits met can alter eligibility.
2) Assuring accurate and complete patient information: Mistakes can be produced in data entry when someone is attempting to get speedy in the interest of efficiency. Including the slightest inaccuracy in patient information submitted for eligibility verification may cause a domino effect of issues. Triple checking the accuracy of your own eligibility entries will seem like it wastes time, but it can save time in the long run saving practice managers from unnecessary insurance carrier calls and follow-up. Ensure that you have the patient’s name spelling, birth date, policy number and relationship for the insured correct (just to name a few).
3) Choosing wisely when based on clearing houses: While clearing houses can offer quick access to eligibility information, they most times usually do not offer all information you need to accurately verify a patient’s eligibility. More often than not, a call made to a representative at an insurance company is essential to collect all needed eligibility information.
4) Knowing just what a patient owes before they even reach the appointment: You have to know and anticipate to advise an individual on the exact amount they owe for any visit before they can reach the office. This can save money and time for a practice, freeing staff from lengthy billing processes, accounts receivable follow-up and even enlisting the aid of credit bureaus to collect on balances owed.
5) Having a verification template specific for the office’s/physician’s specialty. Defined and specific questions for coverage regarding your specialty of practice is a major help. Its not all specialties are the same, nor are they treated the identical by insurance provider requirements and coverage for claims and billing.
While we said, it’s practically impossible for all practice operations to operate smoothly. There are inevitable pitfalls and areas vulnerable to issues. It is essential to establish a defined workflow plan which includes combination of technology and outsourcing if needed to achieve consistency and accountability.
Insurance verification and insurance authorization is the method of validating the patient’s insurance details and obtaining assurance by calling the insurance coverage payer or through online verification. This process ensures verification of payable benefits, patient details, pre-authorization number, co-pays, co-insurance details, deductibles, patient policy status, effective date, form of xcorrq and coverage details, plan exclusions, claims mailing address, referrals and pre-authorizations, life time maximum and more.
Datalinkms is a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments. We offer Eligibility Verification for preventing insurance claim denials. Our service starts with retrieving a list of scheduled appointments and verifying insurance policy for the patients. Once the verification is performed the coverage details are put straight into the appointment scheduler for that office staff’s notification.