There are two important questions for which you as a medical practitioner need to know the answer at all times. Would you be getting paid for the service that you are currently providing to a patient and what is the required amount that you need to collect from your patient when they proceed to checkout after discharge. Basic information like co-insurance coverage, deductibles, patient eligibility and payment terms often go unverified when the patient is admitted to a medical facility. Any inconsistencies between the treatment that you provide and what the patient is eligible to receive leads to denied claims and outstanding payments. You do not want this gap in verification affecting your accounts receivable process.

Being struck between an unpaid claim and a patient that is unable to pay their hospital bill is one of the worst places you could be. More so, when you are small or a medium scale medical facility that cannot afford large gaps in payments. Therefore, having a team of compliance and insurance employees to collect insurance information for the patient at the time of admission is something you should think about. It ensures that you will never have to be struck with denied claims again.  Medical insurance verification is a process that is capable of delivering massive advantages.

The Components of a Well Rounded Medical Insurance Verification Process

Most hospitals and clinics discuss payment and insurance information with patients when they call to set up appointments. This is a sure shot way of knowing beforehand what your patient is eligible for and not. Knowing the terms of a patient’s insurance will help you make your medical consultation process more effective since you can discuss the specifics of treatment details with your patient.

The following are the Important Procedures that should be a part of your Medical Insurance Verification Process

Insurance Verification Checklist:-

Create a checklist that will enable your insurance verification staff to streamline the process and gather accurate information. Details ranging from carrier name, patient details, effective and end date of the policy are some of the ones that need to be validated. A checklist based approach to medical insurance verification  will ensure your team of analysts would be aware of missing information at all times. It will also serve as a template to refer to when following up with the patient to verify specific demographics details such as the amount of patient co-pay.

Patient Information Verification:-

Patient demographic information is always a risk mitigation step that helps uncover fraudulent claims and records. Your patient records also serve as a preference point for the insurance carrier to verify the details submitted by the patient at the time of policy issue.

Get a copy of the patient’s insurance card, to double check ID numbers. A follow up with the insurance provider will help you ascertain the validity of the details provided by your customer. A meticulous approach to the verification of patient information will greatly reduce the rate of denied claims from the insurance carrier.

Record Patient Insurance Coverage Details:-

The process of patient insurance coverage verification begins with a review of their eligibility. You need to establish the terms of their eligibility to receive specific treatments. In doing so you can guide the patient to make alternative arrangements for specialized medical treatments when they are mandatory for the recovery of their health.

A detailed recording of a patient insurance details will also help your doctors and physicians to adopt alternative courses of treatment, which are covered under the insurance plan of the patient.

Medical insurance verification plays a vital role in sustaining a good revenue cycle. Smooth reimbursements will always go a long way in making your treatment process more efficient and up-to-date.


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