Verification of benefits is a necessary part of the medical billing process. Without it, a medical practice cannot receive payment for services that are not covered by insurance policies. They must also make sure that they inform their patients that they are responsible for paying the medical bills. The majority of patients do not understand this aspect, so the verification service must also provide them with an explanation of how to handle medical bills if they are uninsured.

What is the Medical Insurance Verification Process?

Medical insurance verification is a critical step in the healthcare system. It allows doctors to see which patients are covered by their insurance plan. When a patient doesn’t have insurance, or their policy is invalid, a doctor will have to contact their insurance company to verify their coverage.

Insurance information can be confusing and rapidly changing, so it is important for hospitals and clinics to keep up with changes in coverage and deductibles. This helps them to make accurate financial decisions and avoid payment delays. In addition, it protects them from non-covered services and lapsed insurance coverage. Moreover, this process can prevent the practice from incurring large debts. In short, the insurance verification process in medical billing is a vital step in revenue cycle management.

Medical insurance verification is the first step in the medical billing process. It involves contacting the insurance carrier to confirm whether the patient’s plan covers the procedure. This is essential for avoiding claims denials and billing errors, which can lead to a high debt burden and poor patient satisfaction.

Medical insurance verification can take up a significant portion of a medical practice’s front-office staff time. Rather than hiring front-office staff to complete this task, some practices outsource it to third-party medical billing companies.

Medical insurance verification helps healthcare providers get the most accurate information possible about the patient’s coverage, as incorrect insurance coverage can lead to delayed payment and even denials, which can decrease collections and revenues. With an insurance verification process in place, healthcare providers can submit clean claims and enjoy higher reimbursements.

The Significance of Benefit Verification in Medical Billing

Verification of medical benefits is a key part of the patient billing process. It shows whether the patient has insurance coverage and how much they have to pay out of pocket for services. This information is especially important if the patient’s insurance provider doesn’t pay for certain services. This process helps providers get the money they owe and improve patient care.

Without a thorough benefits verification process, a patient’s claim may be denied and the provider loses valuable revenue. A consistent and accurate process is vital to maintaining an efficient revenue cycle and avoiding unpleasant surprises. Benefit verification specialists will follow up with insurance carriers to make sure the information is correct, including the eligibility and benefits information of each patient.

As already mentioned, insurance benefits information can sometimes be confusing. It’s critical for practices to let patients know about any changes in deductibles and other costs before they begin treatment. Patients should also work with medical billing staff to establish payment plans that work for them. Most patients want to pay their bills on time. Benefit verification services, hence, ensure accurate information to patients and protect hospitals from lapsed insurance and non-covered services.

  1. Increases Cash Flow

Cash flow is one of the most important factors to consider for any medical practice. This is because the amount of cash a practice receives is dependent on the number of patients it sees. Using a verification process to capture patient information and reduce claim errors can significantly improve cash flow.

Most medical practices rely on third-party payers for most of their cash flows. However, these payments often take months to reach medical practices. As a result, delays or rejections of payment requests can be a major problem. If payment requests are denied, the practice must resubmit them, a process that wastes much time and monetary resources.

Verification of medical benefits reduces the number of denied claims by decreasing the amount of time staff members spend processing insurance claims after a patient visits. It also increases cash collections by reducing the number of claims that are rejected by insurance companies. Moreover, it reduces the time spent following up with patients after a visit.

Medicare has made certain adjustments to the way they reimburse physicians. For instance, in the last year, the average payment for a physician’s services per RVU (Relative Value Unit) has decreased by 3.3%. In addition, Medicare has also made modifications to reflect inflation and other factors that affect the cost of physician services. As a result, these Medicare adjustments have had a significant impact on the cash flow of many practices.

Cash flow is essential for the survival of a healthcare facility. With a positive cash flow, a medical practice can invest more in a physician’s practice. It is important to understand how a physician’s compensation is determined. This will affect both cash flows and profits.

  1. Minimize Claim Rejections and Denials

Verification of medical benefits helps medical practices manage and reduce claim rejections and denials. The process involves verifying the benefits of the patient before submitting a claim. Verification of medical benefits can reduce the number of claims denied or rejected by insurance companies. For example, claims with incomplete or invalid payer IDs may be rejected. The verification process includes verifying that the billing provider is credentialed, has enrolled in a clearinghouse, and has the correct tax ID.

Verification of medical benefits is a vital step in any healthcare profession. Any mistake in this process can result in unpaid claims. And because the revenue cycle of any healthcare service provider operates on finances, accurate billing and benefits verification are essential to keep it running smoothly.

Likewise, verification of benefits helps medical practices avoid denials and increase reimbursements by tracking trends and making necessary changes. It also provides valuable insights into the revenue cycle. For example, a practice can determine the reasons for denials and correct them quickly.

Claims rejected due to a lack of benefits verification are not uncommon. The administrative staff in a hospital must check the insurance eligibility of each patient to avoid denials. Claims denied due to improper verification are subject to appeals. Moreover, they can cost as much as 8% to 14% of the billing company’s revenue.

In addition to denials and claim rejections, patients are affected by patient insurance claims. Denials can affect both cash flow and patient relationships. While some denials are ultimately overturned by the patient’s appeals, others are not. Despite the delays, medical practices can still appeal denials. If this is the case, a comprehensive utilization management strategy will give them an edge in the appeals process.

  1. Improves Patient Satisfaction

Verification of benefits is an important aspect of the patient experience. Patients can be disappointed if they receive a bill for services that are not covered by their insurance plan. Correct explanations of benefits lead to higher patient satisfaction. It also helps to reduce claim denials. In addition, an accurate benefits verification process ensures that patients pay the correct copay and avoid unexpected out-of-pocket costs.

See Also: Why Are Patient Statements Necessary for Improving RCM Practice?

The Bottom Line

In today’s complex healthcare environment, ensuring patient eligibility is crucial for collections. Ensuring a patient’s eligibility before they even see a doctor is essential for reducing the chances of their medical claims being denied. A lack of benefit verification is one of the most common causes of medical claim rejections.

Verification of benefits reduces denials and increases collections by ensuring that patients have the proper coverage for their services. It also helps healthcare providers submit clean claims and reduces denials and write-offs due to inaccurate patient information. Verification, thus, improves patient satisfaction and reduces provider and patient debt.

Insurance verification is essential to a medical practice’s revenue cycle. Without it, your practice will face a high risk of receiving unpaid claims for services provided. To help ensure a seamless check-in experience for patients and optimize revenue collection, we recommend outsourcing this responsibility to the experts. At Precision Hub, we offer complete insurance and benefits verification solutions to save you from losing on your revenues, enhance your patient base, and improve your overall practice’s reputation.