The cost of quality healthcare and health insurance continues to increase in the United States. This prompts some individuals to choose health insurance programs that might not necessarily meet all their needs. Worse still, they might not be aware of certain coverage gaps when they seek out necessary services from practitioners like you.

This simple pattern alone can increase your chances of experiencing a denied claim or other complications that can interrupt your once consistent revenue stream. One way to prevent these problems is by implementing an efficient and effective patient insurance eligibility verification protocol.

Why Patient Insurance Verification Is So Important

Patients typically approach a medical practitioner with the expectation that your practice will verify their coverage. Indeed a lot of patients are unclear about just what treatments and services are covered in their policy.

Establishing a set of policies and practices to vet or prescreen incoming patients, new patients, and existing patients who may have experienced a change in coverage helps prevent denied claims and other interruptions in your practice’s revenue stream.

While new patient intake naturally calls for insurance verification, it should not be the only time that you verify their degree of coverage. Installing in-office protocols to verify a patient’s coverage should start with the date of service and subsequent follow up appointments.

Not only does this prevent a claim denial from interrupting your revenue stream, but it also helps the patient understand any additional costs, such as co-pays and prescriptions that they might be held responsible for. Ideally, you should weave insurance verification as part of the scheduling process. This will prevent last second surprises should a patient have insufficient coverage for the intended procedure.

This also helps increase patient satisfaction levels. As many patients who experience a claim denial or insufficient coverage tend to take a hard stance on the healthcare provider, even if it is the insurance provider denying the claim.

Preparing For Possible Problems In The Patient Insurance Verification Process

There are a few potential problems that can pop up during the patient insurance verification process. Being mindful of them and putting policies or protocols in place in advance can help prevent claim denials.

Manual Entry Errors

The higher the volume of patients you service the more likely you are to experience data entry errors. Something as simple as a typo in a patient’s insurance card number can lead to a claim denial from an insurance provider or other potential interruptions in your practice’s revenue stream. This is even more likely to be an issue in a small practice or a solo practitioner where an administrative person has to wear multiple hats, that go beyond specializing in data entry.

High Overhead Costs

The overhead cost of employing administrative staff specifically for the task of medical billing, coding, and insurance verification can cut deep into the profitability of a small to medium practice. This prompts many solo practitioners and small practices to outsource their medical billing services to a third-party vendor.

Increased Turnaround Time

Insurance providers are sometimes slow in paying out claims. Even when those claims involve covered services. This is even more likely to be an issue if there is a manual coding error that calls for the re-verification of the patient’s insurance coverage.

Policy Changes

It’s not uncommon for a patient’s coverage to change even while under the same insurance provider’s umbrella. This could be due to changes in employer-offered benefits or a patient who reduces their coverage level to help save money on their monthly premium costs.

Key Steps To Ensure Accurate Patient Insurance Eligibility

There are a few things you can do to reduce the risk of interruptions in your practice’s revenue stream caused by errors in patient insurance verification.

Implement A Checklist Process During The Scheduling Phase

This can be as simple as training your administrative staff to include insurance verification at scheduling. It includes collecting the patient’s insurance information, with their name, date of birth, address, and other key demographic information. Then repeat it back to the patient as it is entered to ensure accuracy.

Verify Directly With The Insurance Provider

When verifying coverage with the insurance provider, make sure your administrative staff also verifies policy coverage for things like diagnosis, related procedures, prescription coverage, and the anticipated treatment plan. It’s also important to double-check if there are referral requirements. Some insurance providers will only cover specialist procedures if they are referred by another physician or diagnostician.

Inform The Patient In Advance Of Any Out Of Pocket Costs To Them

Co-insurance, co-pays, partial service coverage, and prescription costs might be passed on to a patient. Many patients might not be aware of these costs or holes in their coverage, which could lead to delays in payment or failure to pay promptly. Should the insurance verification process yield this kind of information, your administrative staff should immediately reach out to the patient to make sure they are aware of their potential financial responsibilities.

The Benefits Of A Streamlined Insurance Verification Process

There are several benefits to streamlining your insurance verification process and maintaining strict protocols for each patient.

Consistent Revenue Flow

With fewer delays and denied claims your practice will enjoy a more consistent stream of revenue by implementing comprehensive insurance verification procedures.

Fewer Medical Billing Coding Errors

Verifying a patient’s insurance coverage can also help catch medically billing errors before they occur.

Reduced Turn Around Time In Paying Claims

When insurance coverage is verified in advance payers are less likely to delay claims, leading to faster payment and greater revenue flow to your practice.

Improved Patient Satisfaction Levels

When a claim is denied, delayed or the patient is surprised by their out of pocket costs, it lowers their satisfaction with your services. Even if it was the insurance provider who denied the claim. When insurance verification is carried out in advance both you and the patient are better informed and they are more likely to report higher satisfaction levels. This can also go a long way toward improving patient & physician relations.