Every physician and medical practice suffer with unpaid claims and payment rejections for the service rendered. While it is obvious that the physician and the medical practice are entitled to get the payment for the services rendered which cannot be denied practically. However going by the insurance policy and the coverage and benefits applicable to the policy member, the insurance has all the rights to deny a claim by not paying if the policy clearly mentions the service not covered. Evidently this is one of a case which emphasis the importance of Insurance Eligibility and Benefit Verification.
Importance of Insurance Eligibility Verification
Insurance Eligibility Verification helps achieve accurate insurance coverage and benefit details prior to the Patient encounter and medical procedure, which in fact helps during the revenue cycle management services to ace up the billing process and also in guaranteed reimbursement from insurance. In case of procedure not covered under the given insurance policy, this process also helps the physician understand the patient responsibility to avoid payment loss.
While the importance of Insurance Eligibility and Benefit Verification is clearly proved; results can be guaranteed only with effective and efficient process in place. Below step by step process can help optimize Insurance Eligibility Process for guaranteed results.
Checklist for Insurance Eligibility Verification
Having a complete checklist for proper Insurance Eligibility Verification Process in place is the first and foremost step for efficient verification process.
- Insurance policy start and lapse date
- Insurance coverage details like coverage amount, procedures covered, services exhausted and applicable patient responsibility
- Beneficiary and dependent details
- Provider and practice in network with the insurance
- Copay, deductibles and co-insurance details
- Procedure requires Prior Authorization and referrals
- Policy limitation and exclusions
- Documentation required for claim processing if anything exceptional
Procure Patient’s Insurance Card Copy
Getting the updated Insurance card copy from the patient is an essential step to ensure accurate insurance related information and also helps verify coverage and benefit details pertinently. Always ensure an updated insurance card copy is placed in the EMR for immediate reference
Verification Process
The process of Insurance Eligibility Verification needs experienced team trained and skilled to verify and get updated information on all aspects without missing out on anything to avoid repeated follow ups and delay in the verification process and rendering treatment to the patient. There are various ways to approach insurance company for insurance Eligibility Verification.
- Using Integrated EMR and Billing system to contact Insurance and verify
- Using Phone call using provider hotline number
- Setting up Electronic Eligibility Verification system
Collect and Note accurate data
During Insurance Eligibility Verification it is essential to follow the checklist and get the most without having to follow up again. Updating the EMR and Billing system with the updated changes in the insurance details is mandatory.
With an experienced and effective Insurance Eligibility Process in place claims denial completely curbed to bring down the denial ratio radically and thereby guaranteeing maximum reimbursement.
About MGSI
MGSI is a national Medical Billing Company located in FL for over 25 years. With our experience and expertise in handling every niche of Medical Billing and Revenue Cycle Management services for more than 600 physicians across the US, we can take up any scope of services with minimal transition timeline. Our quality billing ensures increased claims first pass rate and reduced denials. To know more about MGSI and our services reach out to 877-896-6474 or log on to Insurance Eligibility Verification.