How to Verify Patient Healthcare Insurance

Insurance verification increases your cash flow, reduces denied claims, and maintains satisfied patients.
Insurance verification increases your cash flow, reduces denied claims, and maintains satisfied patients.
Insurance authorization provides you the go-ahead to offer specific services, whereas insurance verification verifies your patient’s coverage and benefits.

Obtaining patient insurance information and checking it with the insurer are both steps in the insurance verification procedure.
Medical professionals interested in learning the details of insurance verification should read this article.
Let’s imagine you had a positive interaction with a patient and are confident in your ability to deliver a positive patient experience. If you learn that your patient’s insurance information was incorrect and your claims were rejected, all of that exhilaration might come crashing down. This negative outcome can be prevented with proper insurance verification prior to a patient interaction. The verification process is not nearly as difficult as is frequently implied, which is good news.

What is insurance verification?

The practice of confirming a patient’s insurance benefits and coverage before an appointment is known as insurance verification. The process of ensuring that a patient’s insurance plan covers the services you offer and is in your network is more crucial. If not, you can either refuse to see the patient or let them know they’ll have to pay the full cost of your services themselves.

In some medical offices, insurance verification is handled by the front desk employees. In this situation, verifying insurance can take up a shocking amount of a staff member’s shift. You can contract with independent medical billing organizations to verify insurance if you’d rather give your front-office employees plenty of time to speak with patients. You can choose which business, whether it’s the user-friendly Kareo or the highly configurable AdvancedMD, might be best for you by reading our reviews of the top medical billing and coding services.

The significance of patient health insurance verification in medical billing
Whether you have been in practice for a while or are just beginning, insurance verification is important.

Denials of claims are reduced. Assume that you still have a patient’s insurance information from the previous year and that it hasn’t changed. Your claims may be going to the wrong payer if their insurance has changed. Naturally, the outcome is an immediate claim denial. In order to refile the claim with the correct payer, you must get in touch with the patient to find out who their proper insurer is. Even yet, the time and money you spent working on the first claim are already gone.

Cash flow is maximized. Your cash flow is also improved by the decrease in claim denials that comes from insurance verification. Consider this: Fewer denied claims equate to more granted claims, which results in faster payment of more money. You’ll approach the appropriate source for your reimbursements the first time if you have accurate insurance information on all of your patients.

Patient satisfaction rises as a result. All of us have experienced this: We went to the doctor for medical care, but we ended up spending far more than we anticipated. Your insurance ought to have paid for everything, right? You have the authority to stop things like this from happening as a practitioner who treats patients. Before the patient’s appointment, just confirm their insurance, and then let them know what it does and doesn’t cover. Patients avoid any pricey surprises in this way.

What is the difference between insurance authorization and insurance verification?

Insurance authorization differs from insurance verification in that it involves securing an insurer’s consent for specific treatments. Insurance verification entails verifying a patient’s insurance details. The procedure for preparing and submitting medical claims is distinct from this approval. Instead of a retroactive motion for payment, it is a sort of prior authorization for services.

In the event that specific therapies, medications, or examinations are required for your patient’s care, insurance permission may be required. Although different payers have varied policies on whether authorization is essential, they all aim to make sure that payer money goes toward high-quality, completely necessary therapies.

Some patients could additionally need insurance pre-authorization for every single visit to a specialist. A referral from a primary care physician frequently fully meets this need.

The procedure for verifying health insurance
Do the following to confirm a patient’s health insurance:

1. During registration and intake, gather patient insurance information.
When was the last time you came across a registration or intake form for a patient without a section for the patient’s insurance details? When was the last time you overheard a patient being asked for their insurance information when setting up an appointment? You probably have no idea how to respond to either query, or perhaps the answer is just never. There’s a rationale behind that. Your verification procedure can begin right away because you have access to a patient’s insurance information right away.

Obtaining patient insurance information at intake entails more than merely inquiring about the patient’s insurance provider. Obtaining the patient’s insurance ID, policy number, and group number, if relevant, is also necessary. A phone number that providers can call should also be on the patient’s insurance card. This number should also be written down.

You should also confirm whether the patient or another party is the policyholder. Make careful to note the patient’s relationship to the policyholder as well as their entire name. You’ll have all you need if you combine the patient’s full name and birthdate with all the insurance data you’ve gathered.

2. Speak with the patient’s insurance provider.
Once you have the patient’s details, get in touch with the insurance, whether you have a great working relationship with them or have never dealt with them at all. Since insurers provide coverage for so many individuals, it may take them a few days to acknowledge and respond to your request for verification.

Start by calling them to introduce yourself. When a representative answers, dial the patient’s insurance company’s number that you have on file. Call back later if you have to wait for what seems like an eternity because insurance provider lines are frequently quite busy.

As soon as you interact with an insurance representative, be sure they have the right to confirm a patient’s insurance information. Next, affirm with the representative that you are transmitting patient information over phone in a HIPAA-compliant manner. After that, provide the patient access to the insurance data you have gathered. For advice on how to do this successfully, see the following step.

To check the patient’s coverage and benefits, several insurers have online portals where you may enter the patient’s information. The findings of your verification could be unreliable, though, as these websites are known for being out-of-date. Thus, phone calls are usually the best alternative for verifying insurance, but in an emergency, internet portals might be a respectable substitute.

3. Make the correct inquiries.
You are prepared to understand the specifics of your patient’s coverage and benefits now that you have an insurance representative on the line and their insurance information close at hand. Start by having the representative confirm all the data you have gathered. Next, find out if the policy is still in effect and when it expires. You should ask the insurer what the patient’s copay will be if the insurance is in fact active. The patient’s deductible information should also be gathered.

You will have now verified the fundamentals of your patient’s insurance policy, but you shouldn’t stop there. Before seeing the patient, you must now determine whether any insurance authorizations are required. Ask about any additional documentation requirements or odd coverage limits as you enquire about these requirements. Finally, using your prior experience, make any inquiries you know are relevant to this particular payer.

4. Before every patient interaction, start at the top.
The complete insurance verification procedure is broken down into the three parts mentioned above. But patients theoretically have the option to change plans or lose their insurance at any time. It is best to obtain the patient’s insurance information prior to each and every appointment, or to provide incentives through the patient portal of your business. This idea is valid whether it has been a year or a week since you last saw the patient.

Do not merely inquire as to whether the patient’s insurance has changed, as this does not provide them with the most up-to-date information you have on them. Show them all the information you have instead, then inquire as to whether it is accurate or needs to be updated. Your insurance verification process is finished if the patient confirms the accuracy of the information you provided. If not, begin at the top and take no shortcuts. Patient satisfaction, claims denial rates, and your cash flow are all at stake.

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