The effort taken by most healthcare entities in minimizing claim denials has become remarkable in the recent times. They pay more attention in documenting patient demographics, entering ICD & CPT codes, updating current charges, performing regular AR follow-up and more. However, their claims still get denied by the Payer. The reason is that Providers and medical billing companies fail to pay attention on the insurance eligibility verification. Most importantly, it has to be done even before a patient visits a Provider. If all the steps in the insurance eligibility verification are followed perfectly, then denial management would become much easier. Let us have a brief review of this process:
Basic Verification: Insurance eligibility verification can be done at two levels and the first one is the basic verification. In this level, healthcare entities verify general information like patient details and insurance coverage period & services. In addition, co-pay, co-insurance, and deductible details are also checked. Verifying all these details in the first 3 months of a year is very crucial. The reason is that most patients fail to meet their calendar-year deductible, which gets renewed every January. This information must be communicated in advance to concerned patients whose calendar-year deductible is outstanding. Only when this deductible amount is paid does the insurance company starts paying for the covered medical expenses. Therefore, Providers must carry out the insurance eligibility verification process prudently to avoid claim denials.
Advanced Verification: It is an in-depth insurance eligibility verification process which includes the basic verification details and in addition also checks the insurance plan’s code-specific benefits, which may have ‘Annual Maximum’ or ‘Lifetime Maximum’ limits. An insurance plan with Annual Maximum benefits states that patients are responsible for bearing medical expenses that exceed the specified limit in that particular calendar year. Lifetime Maximum is the total expense borne by an insurance company until the plan’s specified limit is reached. Once this limit is met, then the patient has to pay out of his pocket. In case, healthcare entities fail to check these details before providing care, then they will have a tough time receiving their payments from patients whose Annual Max or Lifetime Max limits have been reached. This in-depth verification is ideal for Healthcare Specialty Units like Cardiology, General Surgery, Physical Therapy, and specialties that have high $ value services. It helps in effective denial management and faster reimbursements.
Be it basic or advanced level insurance eligibility verification, a renowned offshore medical billing company like eCare can do it perfectly. eCare recently has deployed a dedicated team to carry out the insurance eligibility verification process. The team’s highly skilled professionals do this job efficiently and deliver the benefit details before the turn-around time (TAT).