Medical Billing Expert

Insurance eligibility is an indispensable part of the medical billing process, which directly affects the reimbursement of a practice. Regardless of how much integrity your patients have in disclosing factual information about their health insurance plans, the practice’s reimbursement rate is directly tied to the quality of insurance verification adopted by your staff. There are many severe repercussions to poor insurance verification practices right from delays in payments to complete non-payment of claims and increased claims rejections.

That is why you need the right partner to outsource your insurance verification services to so that your claims denial rate doesn’t increase and result in great financial losses. There are many factors that you should consider before you choose a partner to work with. Some such considerations should include whether they are HIPAA compliant and what kinds of quality control measures they have in place.

Other important factors to consider include how familiar they are with private and public health insurance plans and what kinds of reporting mechanisms they use to monitor their performance. Let’s go over the many factors that you need to consider before choosing your insurance verification partner, right from primary factors to secondary considerations.

Primary Factors to Consider When Choosing an Insurance Verification Partner

insurance verification partner

Covers a Wide Variety of Specialties

When looking for the right insurance eligibility verification partner it is critical that they are well-versed with a lot of medical specialties from dental and physical therapy to chiropractic and radiology services. If they have experience working with a range of specialties, they would know what to look for when assessing each one for insurance eligibility. It is also important that they cover the whole range of highly specialized domains from gynaecology to rehabilitation therapy.

Because these specialities have their own standards and requirements, it is imperative that any medical insurance verification partner you choose is well-acquainted with the type of services they entail. partners that only cover a few specialities will not be able to help you when other specialities require insurance verification like ophthalmology, dental, orthopaedics, or periodontics. Look into the variety of specialities they have experience dealing with to get an idea of just how comprehensive their insurance verification services are.

Knowledgeable About All Major Private Medical Insurances, Medicaid, and Medicare

A good insurance eligibility verification partner will have in-depth knowledge of all medical insurance plans and providers from private medical insurance to Medicare and Medicaid. Medicaid provides health insurance coverage to million of Americans from low-income adults to pregnant women, children, elderly adults, and people with disabilities.

Medicare on the other hand provides health insurance coverage for seniors over the age of 65 for the most part, and then some adults with disabilities younger than 65. Both are government-run programs for Americans who generally struggle to pay their medical bills. Both help individuals pay for their healthcare expenses and have different requirements that need to be met in order to be eligible.

The partner you outsource insurance verification to must have vast experience dealing with all types of medical insurance carriers and plans so that it takes less time to clear individuals with coverage. Experts in this area will know what red flags to look for when processing insurance verification requests so that no uninsured patients enter the system and lead to massive claims denials.

HIPAA Compliance

When looking for an insurance eligibility verification partner it is critical that you determine whether they are HIPAA compliant in their practices or not. Because HIPAA sets the standard for the protection of sensitive patient data, without it your practice will find itself in a lot of hot water. Not only will you have to face severe consequences from being non-compliant, but you will also be subject to fines that go up to $1.5 million per violation. To avoid such situations from arising your protected health information (PHI) must have network, physical, and process security measures in place.

These security measures must be adhered to at all times to ensure HIPAA compliance is being met at your practice. From audit reports to tracking logs you must ensure that all your activity is recorded on hardware and software and that it meets compliance standards across the healthcare industry. Because HIPAA updates its policies and requirements on a regular basis, you must ensure that the partner you choose to work with keeps a track of changing regulations so that they stay compliant at all times.

Stringent QA Checks

When you outsource your healthcare insurance verification services, it is critical that you verify whether they have stringent QA checks in place already. This way you can ensure that all the insurance verification work they do has been thoroughly vetted for high quality and accuracy. Quality assurance checks are key to performance. That is why you need to check for all types of errors right from typos and system errors to specification errors and coverage inaccuracies.

Random auditing should also be a part of their quality assurance process so that they can ensure compliance with all quality controls. It is a good sign if every team is provided with a daily or weekly quality report.

This report should evaluate the performance of each staff member and track the types of errors and the number of errors they generate on a regular basis. These metrics should then be monitored and reviewed so that critical measures can be taken to minimize errors and improve accuracy. Periodic appraisals should also be conducted so that every staff member knows where they stand and so that they can aim for better quality control performance as well.

Detailed Reporting

When you outsource insurance verification you need to ensure that the partner provides detailed reporting for performance, outcomes, and quality control on a consistent basis. The reports need to contain information like how many patients have to pay deductibles and, if so, how much of the deductible has been met? Reports should also cover how many claims came back denied because the insurance verification information was incorrect.

The number of insurance verifications conducted in a day and the percentage of out-of-network benefits that have been recorded should all go into the reports as well. This way the healthcare provider knows what numbers to track and how to improve performance for every insurance verification specialist. With frequent reporting you can gain a better understanding of how your practice is doing against industry benchmarks so that you can aim to perform better the next quarter.

Anything that can be measured can be improved. So it should be with quality control. If the number of denied claims reduce because of new measures that were implemented in the insurance verification process, quality control can be seen boosting business performance. Make it a point to ask the partner to what extent they provide detailed reporting because it will make a huge impact on your potential losses and profitability in the future.

Secondary Factors to Consider When Choosing an Insurance Verification Partner

No Setup or Training Fees

It is also important that you vet insurance verification companies for end-to-end services. This means that they do not charge you extra fees for setup or training because it is already included in the services they provide you. If a partner’s insurance verification process involves setup charges, you can rest assured that you are not getting a good deal. Do your research beforehand to ensure that all the services are being charged at one time and that no additional expenses find their way into your final bill. You do not want to be surprised at the end, so enquire with the partner before you start as to what is included in the services you are being provided.

Once you collect all the fees and charges that they will be billing you for throughout the insurance verification process, sit down with them to discuss your expectations. Make it very clear that you will not be entertaining any additional charges outside the ones you have already agreed to pay as you are looking for a partner that provides end-to-end medical insurance verification services.

Affordable Pricing

It is critical that you look at how much the partner is charging for their services before you decide on one to partner with. Although one of the biggest reasons to outsource insurance verification is the cost savings, you should be sure that cost cutting isn’t a primary factor in this equation. The reason that it shouldn’t be a primary factor to consider is because the most affordable partner will not necessary be the one providing the best service. While you should look forward to drastically cutting down your costs by using this partner, it shouldn’t be your chief criteria to onboarding help in this area.

To help you provide superior medical care and keep revenue coming in you should be focused on finding a partner that has invested in quality control and HIPAA compliance first and foremost. Cost considerations should ideally take a back seat because regardless of which service provider you go with, outsourcing will result in cost savings any way.

There are hundreds of factors that healthcare providers should ideally look into to assess whether an insurance verification partner is right for them. These could include both primary and secondary factors, from implementing quality control measures to affordable pricing. It is critical that healthcare providers look into important factors like access to detailed reporting and HIPAA compliance when they start looking for a partner.

This is because as a business partner to your operations, you need to be able to monitor their processes and measure how effective their solutions are. You also need to be able to ensure that will not be facing HIPAA violations when you bring another partner on board.

If you choose a partner, always be sure that they have elaborate knowledge of all health insurance plans and carriers so that insurance verification can be completed effortlessly. Without the right expertise, your partner could just be wasting your time and letting patients who have zero insurance coverage enter your system because they were not vetted with care.

If getting maximum reimbursement for the medical care you provide is a priority for you, you will spend a significant amount of time carrying out in-depth research on the partners. That way, you know who you are dealing with and the quality of services they will be bringing to the table.

Proper insurance eligibility verification will lead to fewer claims rejections and denials as only patients which insurance coverage will be entered into the system. When it is leveraged alongside accurate billing and coding services, not only will your practice increase your clean claims rate, you will also improve your cash flow. By having insurance verification of the highest standards you can also look forward to minimizing your bad debt as more claims are approved and reimbursed in a timely manner.

You can also increase your patient satisfaction as less surprises are in store for them when it comes to paying off their medical bills. Fewer denials also means that your operations are less prone to stringent audits by your insurance carriers. By investing in outsourcing your insurance verification process you not only enhance your revenue generation but also ensure greater quality medical care for your patients.

Who We Are and Why Our Expertise in the Industry Matters?

This article is brought to you by MedBillingExperts, an enterprise-grade revenue cycle management solution provider. With over 10 years of experience in the industry, we provide high-quality end-to-end solutions for all our clients’ revenue cycle management requirements. We provide insurance verification services that help determine how well patients are covered by their insurance policies and whether they can be provided with medical care or have to dig deep into their own pockets to get the medical care they deserve.

By evaluating whether insurance coverage actually exists in the first place, we can ensure that no unforeseen complications arise later on when it comes time to pay the medical bill. Healthcare providers and professionals alike come to us to get professional advice, understand upcoming healthcare trends, and gain new knowledge of evolving industry best practices. We are authorities in our area of expertise so that we can help healthcare providers across the country continue to thrive for years to come.


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