Crucial Medical Insurance Verification Steps That Every Practice Must Follow

Insurance coverage issues are one of the top reasons for claim denials in the United States. So far, millions of claims have been denied because eligibility had expired or the plan did not cover the service.

That is why practices must implement a rigid patient eligibility verification process. That only can help practices reduce the denials and make the billing more efficient, thereby improving the overall bottom line.

Medical insurance eligibility verification should be done before any service is provided. This backend task determines the practices’ profitability and ensures that providers do not leave their money on the table.

Here are five critical steps that can help any practice reduce claim denials and improve the financial base.

1. Insurance Verification Checklist

Make it a point to ask the right questions during medical insurance verification. The office staff should punch in the information gleaned from the insurance card, electronic eligibility systems, or phone calls to the insurance companies.

The insurance verification in medical billing should include information such as

Insurance name
Phone number
Claims Address
Insurance ID
Group number
Name of Insured
Relationship of the insured to the patient
Effective & end dates of the policy
Whether coverage is active
Whether the insurance covers diagnosis, procedures, or services to be provided
Whether your practice participates in a plan
Limitations of policy
Whether referral or pre-authorization certificate of medical necessity is mandatory
The amount for the patient’s copay & deductible.

2. Obtain a copy of the insurance card

Start the insurance verification process by asking for a copy of the insurance information from the patient. Even if a patient states that the insurance has not changed, getting a copy is always a better idea.

You should have an updated copy of both sides of the insurance card in your EHR. That will help you with an informational backup in incase someone mistypes the information in your records. Always make sure to double-check the ID numbers before sending out the claims.

3. Contact insurance provider

It is wise to refrain from taking the information on the card at its face value. Insurance coverage can change or get discontinued a few weeks after the card is issued. A solid step would be to call the insurance company directly to verify the details.

4. Record correct information

Your office staff has to be trained to be extra cautious when it comes to transcribing information into patient records. The information you acquire and your patient record system is the foundation of your claim. A single transposed number can be the difference between a clean claim and a denial.

Practices should never rush through the insurance eligibility process only to make errors. Haste and inaccurate data can results in weeks of delay in the payments, and in some cases, claims could go completely unpaid.

5. Followup whenever necessary

If you have any questions or concerns regarding a patient’s insurance eligibility, make follow-ups. You can always communicate with the patient and inform them about the copays or other issues.

It is a good idea to inform the patient in advance if there is a possibility that there are going to be out-of-pocket expenses. Last-minute surprises are not a good idea in such cases.

Capline Healthcare Management can help.

Capline Healthcare Management is one of the leading healthcare assistance companies in the United States. We have helped 400+ practices reach the optimum revenue levels by streamlining their operations.