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Owing to the importance and need for new healthcare measures that people need access to, the healthcare industry is growing rapidly around the world. At the same time, every healthcare company is fighting to stay relevant amidst rising operational costs and high competition. In order to keep their overhead low, most healthcare companies are turning to healthcare outsourcing services. The global medical billing outsourcing market is experiencing a marked surge.

Healthcare service providers and the insurance industry already outsource data entry, medical transcription, and other case management tasks. Currently, it is the medical insurance field and insurance verification that is now seeing a lot of outsourcing activity.

What is Medical Insurance Verification?

The healthcare industry is fraught with regulatory changes and there is a lot of confusion about the best practices to outsource medical insurance as a result. The same confusion exists among patients as well, who regularly have doubts such as "how are eligibility checks handled?" or "what triggers an insurance verification?" when they want to claim one.

Apart from those in the know, even healthcare providers are sometimes unaware of how the insurance mechanism works. The difference between premium, co-pay, co-insurance, deductibles and out-of-pocket maximums is also blurred for many. Patients on the other hand constantly feel they are cheated because they pay high premiums while still having to deal with out-of-network payments which are huge burdens in times of necessity.

In such cases, the importance of the insurance eligibility verification process becomes paramount. This is because it makes the entire insurance process more stable, ensuring you, as a healthcare provider, do not pay out from false insurance claims. It also ensures that customers are always kept in the loop regarding when and how the insurance provider will cover their incurred costs.

What Are the Different Types of Eligibility Verification?

One of the major reasons for claims rejections after insurance verification is conducted is that customers fail one of the two verification processes set in place to ensure strict compliance. These are -

  1. Basic Insurance Verification Process

    Basic insurance verification is essential for a smooth medical insurance process and allows you to quickly check if the customers with basic insurance policies have renewed them continuously or not. Details collected under this include -

    • Eligibility timelines
    • Patient details (name, address, claim limit, contact information, plan details, pre-existing criteria)
    • Within network or Out-of-network services
    • Co-pay and deductibles
    • Co-insurance
    • Dependent insurance
  2. Advanced Insurance Verification Process

    When it comes to advanced insurance verification, the insurer first needs to ensure all steps under basic insurance verification are completed and vouched for. Thereafter, the insurer proceeds with the following checks -

    • Claimant insurance renewal frequency
    • Details of health fund usability
    • Co-pays for tests, lab fees, etc.
    • Any existing pre-certifications and their checks
    • Other inclusions and exclusions

Why is Insurance Eligibility Verification Important?

One of the main reasons behind the importance of insurance eligibility verification is that without verification, healthcare services will most probably derail. It is directly linked to claim denials, payment delays, and accounts receivable activities, all of which can suffer equally if eligibility verification is not performed properly.

Therefore, it is imperative that the verification is carried out step-by-step as laid down below, and will shed further light on why this process is extremely crucial to the overall healthcare insurance sector -

  1. Patient Scheduling

    Patient Scheduling

    Patient scheduling is extremely convoluted and needs to be streamlined for healthcare providers to go about their job with ease. Nowadays, with automated scheduling software and online access to real-time updates, prioritization of appointments can be achieved with far larger success. Many hospitals and caregivers now employ a whole suite of services which include email and text notifications, canceled appointment rescheduling, etc. for a more robust experience.

  2. Patient Enrolment

    Patient Enrolment

    For any healthcare provider, patient demographics are part of the core dataset. Once again it is a convoluted process, and most healthcare providers need to work with insurance providers to figure out which information is important and which one is not.

  3. Eligibility Verification

    Eligibility Verification

    This remains one of the most neglected aspects of insurance verification and if done right, can increase the number of "clean" claims while making it simpler for healthcare providers to clear the backlog of payments. This process ensures a smooth overall process while solving issues related to delayed payments, reducing errors, enhancing patient satisfaction, etc.

  4. Coverage and Benefit Verification

    Coverage and Benefit Verification

    Insurance verification ensures the periodic checking of all patient coverage and benefits under the insurance plan. This becomes easier with an accurate record of patient insurance history, which takes into account changes like marriage, the inclusion of new family members, divorce, and other variables that can change insurance coverage and benefits.

  5. Pre-authorization of Treatment

    Pre-authorization of Treatment

    Prior authorization for treatment is obtained from the insurance payer in case of delayed and planned surgeries, etc. to ensure all the details are recorded and everything is in place for when the day arrives. This ensures better patient satisfaction and a smoother check-in and check-out process.

  6. Billing System Update

    Billing System Update

    Once all the patient details have been received, the details which include coverage information, etc. are updated in the billing software, making it easier for payments to be made down the line.

Why Should I Outsource Medical Insurance Verification?

Ever found yourself asking the question "why is insurance eligibility verification important?" There are countless reasons, but one of the most important ones is that choosing to outsource this important but time-consuming process can help you enhance the efficiency of your existing processes. Choosing to outsource can help in the following ways –

Efficient appointment scheduling procedures through the help of automated appointment scheduling software
On-call team members to educate patients about financial coverage and their insurance-related obligations
Ability to instantly verify each patient's coverage with multiple payers by contacting insurance executives through a medium such as voice calls, insurance portals, etc
Ready access to the latest up-to-date patient information. Outsourced billing teams can easily keep the details ready while verifying eligibility, identifying the coverage period, and full claim details
Outsourcing can also ensure there is a team of people working to follow up with patients and check all issues arising out of insurance eligibility. This ensures problems related to denials can be sorted amicably
Real-time verification processes to help update and store patient data

Benefits of Insurance Eligibility Verification

Insurance verification plays an extremely important role in speeding up the entire process of medical billing. By easily verifying insurance eligibility you can ensure lesser time is spent on avoiding claim denials and rejections caused due to patient ineligibility. Have you ever wondered how fast are medical insurance verifications are made? In that case, outsourcing is the way to go. By choosing to outsource, you can benefit from the following -

  • Increased Cash Flow

    With the help of insurance eligibility verification, you can streamline your existing claims submission and claims denial process. Thisallows healthcare practices to manage their cash flow, write off bad insurances, and improve overall patient care.

  • Enhanced Workflow Procedures

    When you work with a service provider for insurance verification and credentialing, you can help improve and streamline the process of revenue cycle management. This further boosts the efficiency of your organization, leading to lesser denials in claims and improved patient experience.

  • Increased Self-Pay Revenue Generation

    As patient information gets duly collected and notarized, you immediately see an increase in self-pay revenue because the up-to-date patient information gets matched to your healthcare database. This further ensures that every patient has a trackable record of their existing insurance cover, submit claims post-cross-checking, and the latest cover status online.

  • Better Communication

    Communicating with your patients and completing all their paperwork is time-consuming and neglect can often lead to more issues down the line. By simplifying the communication process through automated communication processes.

  • Customer Satisfaction

    One of the primary goals of healthcare providers today is to ensure complete customer satisfaction. As a result, insurance companies need to up their game when it comes to providing round-the-clock support, better self-care systems, etc. software meant for insurance eligibility verification can do this and much more.

  • Improved Scheduling

    Patient scheduling always remains a tough ask, especially for large healthcare centers dealing with cancellations and re-appointments on an hourly basis. Insurance verification allows you to fasten this process, by simplifying the system and giving cadence to the patients who have the necessary coverage.

Outsource Insurance Verification Services to Flatworld Solutions

For most healthcare providers, clinics, and hospitals, insurance verification is a time-consuming process. However, the billing process is crucial to your overall success. Outsourcing health insurance verification lets you concentrate on the core functions of your business and focus on profitability.

At FWS, our entire process of medical insurance verificationis designed from the group-up for US-based companies who need expert guidance and support to manage their insurance verification process.

Contact us now to learn how we can help you with our offerings.

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