Medical claim denialIf you want to safeguard the fiscal health of your practice, it is important to ensure services are billed correctly and collections are maximized. This starts with insurance verification on the front-end and it is a very simple task that can benefit the patient and the healthcare provider.

Proper insurance verification and authorization before treatment is administered accelerates and streamlines the medical billing process. It involves validating the insurance details of a patient and obtaining assurance through online verification. The process verifies certain pieces of information, such as payable benefits, co-pays, co-insurance details, patient details, deductibles, type of plan and coverage details, the effective date of coverage, policy status, claims mailing address, plan exclusions, and the pre-authorization. All of this information is very important.

Financial Implications of Neglecting Insurance Verification

Through insurance verification and authorization that is obtained before patient treatment, maximum efficiency is achieved. This is one of the most comprehensive medical billing solutions that you have access to. In all, insurance verification and pre-authorization can benefit the entire healthcare industry by doing the following:

  • Enables the industry to maximize receivables by reducing the number of insurance claim denials.
  • Reduces the chances of the insurance company asking for more documentation, thus lengthening the period of time it takes to have a claim paid.
  • The workforce is better able to concentrate on core tasks.
  • Operational costs can reduce by up to 40%.
  • The billing process is smoother, requiring less manpower to execute it.
  • Less bad debt, resulting in fewer write-offs.

If medical coverage is not verified before treatment is administered and no pre-authorization is given, then there is an increased risk of loss. Insurance payments are how hospitals and doctors receive what is due to them for the treatment that they provide.

If it is found through pre-authorization that the insurance company will not authorize a procedure, then the healthcare provider can find out whether or not the patient wishes to take financial responsibility for the charges or if they want to utilize another option. This keeps the patient and the healthcare provider from being presented with a surprise later.

Impact Insurance Verification has on the Patient Experience

As for the patients, they can be rather disgruntled if they receive a denial in the mail for an insurance claim that states that the services were not covered or the procedure required pre-authorization. The first question that comes to the patient’s mind is, “Why didn’t someone tell me about this ahead of time?” when a patient is informed ahead of time, they can make an educated decision about their care so they are not dealt a financial blow. If a patient cannot afford the treatment that was administered, then the healthcare provider loses money due to the patient’s inability to pay.

The patient is also able to learn about what their financial responsibility would be if they were to use that provider. The patient could learn that they would have to take complete responsibility or partial responsibility for the charges, depending on whether or not the provider is in-network or out-of-network. If the provider is out-of-network, the insurance company could allow partial payment compared to an in-network provider or they could deny coverage completely. The patient can then decide whether or not to stay with the provider and assume a much greater financial responsibility or to choose an in-network provider that would lessen their financial responsibility.

The important thing is that the patient and the healthcare provider learn through insurance verification whether or not procedures are authorized before they are performed.

First Steps Toward Solidifying Front-End Procedures

If you need to implement a better insurance verification system, professional medical billing consultation can help you get on the right track. Pre-authorization is the first step toward having a sound billing system. With new changes occurring, such as the implantation of ICD-10, it is very important to get every step of the process nailed down so that insurance claims denials are reduced. With ICD-10, more scrutiny will be given to documentation since the standard is one that requires a high degree of accuracy in medical billing codes and other supporting information. Through pre-authorization, healthcare providers do not have to worry about filing claims that will be automatically denied because they are not covered by the patient’s medical insurance.

With the help of a consultant, you can effectively and quickly implement procedures that will ensure smoother operations, fewer errors, and increase productivity. This will have a positive impact on the bottom line of your practice or facility, which, in turn, makes care more affordable for patients.

Contact MD Pro Solutions today to improve your front-end procedures and reduce denied claims and other billing issues. Fill out the form on our contact page or call Greg Keilliher at 508-923-7610 today.