How do you verify patients’ health care insurance?

  • Insurance Verification maximizes your cash flow, minimizes your rejected claims and keeps your patients happy.
  • Insurance verification verifies your patient's coverage and benefits, while the insurance authority gives you a green signal to provide certain services.
  • The insurance verification process involves collecting patient insurance information and verifying it with the insurer.
  • This article is for medical practitioners who want to know about insurance verification.

Suppose you had a good experience with a patient and you feel that you have provided a satisfactory experience to the patient. If you find that your patient's insurance information was incorrect and your claims were denied, this enthusiasm may subside. Proper insurance verification before the patient is visited can avoid this undesirable outcome. The good news is that the verification process is nowhere near as difficult as it is often assumed.

What is Insurance Verification?

Insurance verification is the process of verifying a patient's insurance coverage and benefits prior to an encounter. More importantly, it is the process of verifying that the patient's insurance plan covers the services you provide and is in your network. If not, you can either prevent the patient from seeing you or inform them that they will have to pay for your services completely out of pocket.

In some medical practices, front-office workers handle insurance verification. In this case, insurance verification can cover a staggering portion of a staff member's workday. If you want to ensure that your front-office staff has enough time to interact with patients, you can outsource insurance verification to third-party medical billing companies. Our review of the best medical billing and coding services can help you decide which company, whether it's a user-friendly one or a highly customizable advanced MD, might be best for you.

TipTip: You can outsource insurance verification to third-party medical billing companies if the process would be too challenging to handle in-house.

Importance of Verification of Patient Health Insurance in Medical Billing

Insurance verification equally matters whether you have been practicing for a long time or are just opening a medical practice.

  • This minimizes claim denial. Let's say you have a patient's insurance information on file for the past year and assume their insurance hasn't changed. if their insurance Is has been changed, you can send the claim to the wrong payer. The result, of course, is a quick claim denial. You will need to contact the patient to determine their appropriate insurer and to refill the claim with that payer. Still, you've already lost time and money working on that initial claim.
  • This maximizes cash flow. Your cash flow also improves by reducing claim denials that result from insurance verification. Think about it: Fewer rejected claims means more accepted claims, which means more money more quickly. With the proper insurance information about all of your patients, you'll go to the right source for your reimbursement the first time.
  • It enhances patient satisfaction. We've all been there: You went to the doctor for therapy, but you left paying more than you expected. Shouldn't your insurance cover the whole thing? As a practitioner yourself, you have the power to prevent such unsatisfactory patient experiences from happening. Verify the patient's insurance before meeting with you, then tell them what their plan does and doesn't. This way, patients do not face any costly surprises.

What is the difference between Insurance Authorization and Insurance Verification?

While insurance verification is the process of verifying a patient's insurance information, insurance authorization is the act of obtaining the insurer's approval for certain services. This approval is separate from the process of making and filing medical claims. It is a form of prior authorization for services rather than a retroactive offer to receive payment.

Insurance authorization may be necessary if certain treatments, prescriptions or tests become necessary to care for your patient. Different payers have different rules on when authorization is required, but their goal is generally the same: to ensure that the payer's money goes solely toward needed, high-quality services. Is.

Some patients may also require insurance pre-authorization for any and all specialist visits. Often, a primary care physician referral covers this requirement completely.

significant achievementsImportant achievements: You may need to authorize certain treatments, prescriptions, tests, or specialist visits with insurers before facing the patient.

health insurance verification process

To verify a patient's health insurance, take the following steps:

1. Collect patient insurance information during recruitment and registration.

When was the last time you saw a patient intake or registration form without a field for patient insurance information? When was the last time you heard an appointment scheduling call during which a patient was not asked for their insurance information? You probably can't think of an answer to any of the questions, or maybe it's simple. never, There is a reason for that. With patient insurance information immediately available, your verification process begins immediately.

Collecting patient insurance information upon intake means much more than asking the patient which company insures them. This also means obtaining the patient's insurance ID, policy number and, if applicable, group number. The patient's insurance card should also have a phone number that the provider can call. You should also record this number.

Additionally, you should check whether the patient or any other person is the policyholder. Make sure to enter the full name of the policyholder and the relationship with the patient. Group all the insurance information you collect with the patient's full name and date of birth, and you'll have everything you need.

TipTip: Acquiring complete records of patient demographics offers your medical practice several important benefits, including faster check-ins, insurance verification, and less labor in record keeping.

2. Contact the patient's insurer.

Whether you have an excellent relationship with the patient's insurer or have never worked with them before, contact them after receiving patient information. You should arrive early, as insurers cover so many people that they may need several days to accept and process your verification request.

To start, try contacting by phone. Call the insurance provider number collected from the patient and wait for a representative to respond. If you find yourself waiting for what feels like forever, call later, as insurance provider lines are often quite busy.

Once you reach an insurance representative, verify that the person you are speaking to is authorized to verify the patient's insurance details. Next, confirm with the representative that your current phone conversation is a HIPAA-compliant way of transmitting patient information. Then, share the insurance information collected from the patient. See the next step for tips on doing this effectively.

Alternatively, many insurers have online portals into which you can enter patient data to verify their coverage and benefits. However, these portals have a reputation for being out of date, so your verification results may be inaccurate. Thus phone calls are generally best for insurance verification, but online portals can be a good option in a pinch.

did you know?did you know? The best medical software automates insurance eligibility verification, integrates with major payers' systems to batch-check scheduled patients in real time.

3. Ask the right questions.

With an insurance representative on the phone and your patient's insurance information, you are ready to learn about your patient's coverage and benefits. To get started, ask the representative to confirm all the information you've gathered. Then, ask if the policy is active and when it expires. Assuming that the policy is actually active, you should ask the insurer what the patient will be reimbursed for. You should also collect patient deductible information.

At this point, you may have confirmed all the basics of your patient's insurance plan, but you shouldn't stop there. Now you need to find out if any kind of insurance authorization is necessary before seeing the patient. As you inquire about these requirements, also ask about additional documentation or unusual coverage limits. Finally, ask any questions that you know from past experience are relevant to this specific payer.

4. Start at the top before each patient is visited.

The above three steps comprise the entire insurance verification process. However, patients can theoretically lose insurance or change plans at any time. It is best to collect patient insurance information prior to each encounter, or encourage them to do so through your practice's patient portal. The assumption is true that you haven't seen a patient in a year or a week.

Don't just ask if the patient's insurance has changed, as this question doesn't tell the patient the date of your most recent data on them. Instead, show them all the information you have and ask if it's accurate or needs to be updated. If the information you show to the patient is correct, your insurance verification process is complete. If not, start at the top and don't cut corners. Your cash flow, claim denial rate and patient satisfaction are on the line.

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