What Is The Significance Of Insurance Verification In The Medical Billing Process

What Is The Significance Of Insurance Verification In The Medical Billing Process?

During the public health emergency of COVID-19, federal bodies and insurance payers have introduced a multitude of changes in insurance plans. Therefore, the administrative staff of a healthcare facility should ensure clarity during insurance verification in the medical billing process.

With increased patient flow, healthcare providers should implement a more scrutinized system to validate maximum coverage, benefits, copayments and deductibles. Hence, it has become crucial that healthcare providers should understand the significance of the insurance verification process.

In this article, you’ll get a complete idea of how monitoring of a patient’s insurance plan leads you to optimize your medical billing process and revenue cycle management overall.

But before knowing the beneficial facts, let’s understand the concept of the insurance verification procedure.

Mainly, there are two types of insurance eligibility verification procedures.

1. Basic Verification Process:


It refers to the procedure of verifying and validating the eligibility criteria of an insurance plan for a patient. For this purpose, the registration staff of the healthcare facility should walk through the effective coverage dates.

Moreover, they should also verify patients’ personal information i.e. name, address, contact information, claim limits, pre-existing criteria, and type of the insurance plan.

Also, the front desk staff should examine the validity of basic information on whether the provider is within the insurance’s network plan or out of it.

After verification, administrative staff enters this information into the insurance eligibility verification form. Besides this, they also confirm the co-pay, co-insurance, dependent insurance, and other deductibles.

Medical billing experts basic insurance process to medical care providers who are going to deliver smooth patient care services.

On the other hand, if patients have made changes with their policies i.e. renew the insurance plan or update personal information such as name, address & phone number. Hence, they would not be able to become eligible for the same insurance coverage in the subsequent treatments.

2. Advanced Insurance Verification Process:


Under the advance verification, the administrative staff has to perform all the steps involved in the basic insurance verification procedure.

However, in this process, the registration staff also includes further details i.e. renewal rate frequency (on a monthly or yearly basis).

It also records important details including health fund usability such as the amount of the healthcare insurance plan of the total allocated year.

Likewise, it also involves the collection of co-pay for the tests, lab fees and pre-certification. The administrative staff has to verify all the terms (that are included and excluded) in the healthcare insurance plan.

Now, it might be apparent to you that this procedure is quite complicated. Although, with efficient medical billing solutions_ healthcare providers can boost the speed of their overall billing process.

You should strive to shift towards optimized medical billing services that can help you speed up your revenue cycle management starting from insurance eligibility verification.

Now you might be thinking, that why is the insurance verification process so critical?

Here are the facts that reflect the significance of this process in true terms;

1. Drive Profitable Results:


Have you ever faced a situation, when you prepare medical claims by following all the protocols but still, your medical claim ends up in the form of denial or rejection?

The major reason is that because you used the wrong insights into the medical billing process. If the front desk staff would not verify information from the very first step _ insurance coverage verification. Then the billing staff would not be able to distinguish between co-pays and deductibles.

As a result, it would cause medical billing failure and less revenue. If you want to make sure that you can get payments faster and reduce debt.

Then apply smart billing solutions that can help you validate the true impact of a patient’s insurance coverage. In this way, you can execute your pre-registration processes more fastly. So it would also not cause your patients to wait in long queues for their turn.

Ultimately, it would speed up your business administration as well as improve patient satisfaction.

2. Increase Cash Flow:


If you successfully verify every piece of information about the coverage of the patient’s treatment. Then you also become able to submit a higher number of clean claims.

Because, if you scrutinize important data from the beginning then it leaves no room for mistakes or errors. So you get rid of information silos and optimize your medical billing process.

In this way, you speed up your claim approvals which result in a faster medical billing cycle. Inadequate verification of a patient’s insurance plan and its eligibility can introduce a multitude of risks to the healthcare organization such as claim rejections, denials, and bad debt.

3. Reduce Revenue Leakage:

In order to reduce the number of claim denials, practitioners must ensure accuracy from the beginning of revenue cycle management. And the initial steps of this system consists of the following things;

● Check the eligibility criteria for insurance verification.

● Ensure prior authorization.

It will help you collect accurate information and process clean claims that can bring maximum reimbursements. Since patients have to make changes with the information most frequently. Therefore, providers have to closely monitor any changes/updates in the patient’s healthcare information.

They should have an efficient practice management system in place where they can keep and organize patients’ data. It would also help them to comply with regulatory changes in real-time.

They can also avoid reasons that can cause claim denials, rejections, billing errors and payment delays. In that case, providers will become better able to stop revenue leakage and lead to better sources of revenue generation.

Providers should stay vigilant and make sure that are preparing claims on the basis of verified information.

4. Ensure Patient Satisfaction:


It is the ultimate success of healthcare practitioners that their patients continue to visit them every time they need advice from their healthcare mentors.

Hence, it is the primary responsibility of medical care providers to deliver a satisfactory patient experience every time. For this purpose, they should not only ensure to follow the quality metrics of healthcare services but they should also streamline their business operations.

They should strive to eliminate errors and information silos throughout the revenue cycle management.

Medcare MSO is a reliable medical billing company that provides an all-in-one solution for your overall business administration. Request a free demo of reliable medical billing services to make a difference today.

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