Put quite simply, verifying health insurance benefits takes a series of methodical steps that determine whether their health insurance provider will reimburse your practice for the submitted claim and what the patient’s copayment is.
It’s a complicated process on both ends — the insurer’s and the medical practice’s —that requires focus and attention to detail. However, this time is well spent! Proper insurance verification and pre-authorization of benefits equals faster, more efficient payments, improves cash flow, and minimizes claim denials and rejections.
In addition, the more streamlined the process, the higher comes patient satisfaction—a valuable measure of practice success. By knowing precisely what a patient’s insurance will and will not cover before the appointment, clinicians can better discuss the treatment plan and what the patient’s financial obligations will be.
Benefit verification starts with the pre-registration process. This is when your front office professional will begin the steps needed to enter a complete and accurate collection of patient information into your practice management software. The steps continue with the patient visit and after, if any follow up is needed for the benefits claim.
For best practices in recordkeeping, Clinic-ology advises that patient documentation always be kept in the same place within the patient’s account. In addition, any patient insurance that is not verified by management software should be reviewed at least one day before the scheduled appointment. A visit to the insurer’s website or a call, time consuming as it may be, may clear up any issues or at least verify that the patient is not eligible for benefits. Keep in mind that time spent on verifying benefits gives a great return: quicker payment of claims and of patient copays and greater patient satisfaction.
As Clinic-ology relies on best practices in its training, consulting and workshops, we believe that for comprehensive benefit verification, a checklist can ensure that all insurance and patient information is collected.
Benefit Verification Checklist
Make or request a copy of both sides of the patient’s insurance card.
Contact the insurance provider to ensure the insurance is still active
Determine whether the insurance covers the medical procedure or services to be provided.
Confirm that your practice is a listed provider for the patient’s plan.
Check if a referral is required by the insurance company and, if so, that it is in the patient’s record.
Determine the patient copay required and the plan’s deductible as well as if the deductible has been satisfied in the current year.
Review the limitations or exclusions in the health insurance policy.
Collect and record accurate patient information.
Ensure the correct claims address is recorded. Not all insurance cards include this address and it can be different from the address on the insurance card.
These last two steps are critical because both accurate information and patient expectation of their share of costs usually means a faster, full payment. During the initial patient contact for an appointment, front office professionals should tick off the following:
Patient’s name is entered as it appears on their insurance card.
Patient’s date of birth is entered correctly.
Patient’s social security number is entered correctly.
Whether the patient is the subscriber (or holder of the policy) —if not, request the subscriber’s correct name, date of birth and social security number.
Patient’s date of birth is confirmed.
Patient’s group number and policy number are correctly entered.
Patient is aware of any copays and deductibles and is prepared to pay that amount.
If there are annual or other time-limited procedures, and whether those will impact the patient’s scheduled procedure.
Front office professionals should be trained to take extra care when transcribing information into the patient’s record. This information builds the foundation of the medical claim, and something as simple as a transposed number can mean the difference between a clean claim and a denial. Any error in patient information will likely lead to a rejection or denial of the claim, requiring more team resources to check the information and resubmit the claim. All this equals a delay in revenue for your practice.
Clinic-ology is pleased to offer consultation and training for healthcare practices. This includes the verification of benefits. We offer online and in-person training to keep your practice teams up-to-date with best practices and new options in practice management.
Ready to learn more about how Clinic-ology can help you optimize your practice operations? Schedule your free consultation call with us today using our Quick Schedule Link here.