Does Outsourcing Insurance Verification Make Sense for Your Practice?

Verifying a patient’s insurance is one of the most important aspects of the medical billing process. Proper insurance verification can reduce claim denials and maximize reimbursements, but it can take time and resources that your practice may not have. When medical claims are submitted without verification, it costs the physician and the patient alike.

Most patients have a minimal understanding of the details of their insurance. Deductibles and co-pays can be confusing, especially when there are different amounts that apply for different types of medical services. The patient who has been paying a small co-pay for regular visits to their primary care doctor may not understand that a specialist requires a higher co-pay. Once the services have been provided and they are billed for the difference, there is a risk that you will not receive payment and you will end up with an unhappy patient.

Most people find deductibles even more confusing and some even confuse them with co-pays. Although they may be expected to reach a high deductible amount before their coverage even kicks in, some services are covered, either partially or completely. Learning too late that a procedure is not covered and that they are expected to make up the difference out-of-pocket can be devastating. Luckily, there is a solution: outsourcing your general medical billing to a bpo provider.

As you can tell from the first few paragraphs, this article will discuss a particular segment of medical billing; Insurance Verification. The sooner a patient’s insurance coverage is verified, the easier it will be for them to plan their visits and understand their portion of the financial responsibility. Let’s explore how outsourcing insurance verification works and some of the benefits you will get with these services.

Understanding the Insurance Verification Process

When you outsource insurance verification, the outsourcing provider will typically follow the same general guidelines an employee at your office would. Specifically:

  • Contact the insurer of a patient either via phone call or online verification
  • Verify all details of their coverage, including:
    • Primary and secondary payable benefits
    • Patient details
    • Co-pays
    • Co-insurance
    • Deductibles
    • Patient policy status
    • Effective dates
    • Type of plan
    • Other coverage details

Once the insurance verification is complete, the details will be forwarded to your office.

Potential Problems with Insurance

There are several potential problems with insurance that the patient may not even be aware of. The Affordable Care Act has led to an increased number of people who have insurance and more types of insurance policies to contend with. Those who get their insurance through the Marketplace have the option to change their coverage each year. Although a new plan may seem to be similar to what they had previously, there may be significant differences in some areas of coverage, co-pays, or deductibles. Some plans also limit the covered individual to get care from providers in their state.

Patients may decide on a policy that has lower premiums to make their coverage more affordable. They may not realize the trade-off between lower monthly premiums and higher deductibles or co-pays. Since they purchase the insurance from the same carrier, they report no changes in their insurance coverage. Without insurance verification, the claim you make for your patient is a lot more likely to be denied.

Although most errors in filing insurance claims are unintentional on the part of the patient, there are also those who misrepresent their coverage. To ensure coverage, insurance needs to be verified every time a patient returns to your office. Few if any patients who attempt to get care when they know they don’t have active insurance coverage will make the effort to pay their bill once you have received a denied claim.

Verifying insurance will improve the number and efficiency of reimbursements but outsourcing insurance verification to an experienced virtual healthcare service provider will multiply those results significantly. An expert who has submitted thousands of similar claims is less likely to have costly errors weighing down the process.

What Happens If You Don’t Verify Insurance Coverage?

The vast majority of health insurance claim denials are the result of a patient’s coverage either being terminated or changed in some way. Other causes include billing the wrong insurance company, not having the right co-pay or co-insurance amount, incorrect information provided by the patient, a clerical error at your office, and misunderstanding the deductible details. These denials or delays in payments can result in more time spent on billing, increased collection costs, and bad debt from patients.  Many doctors have chosen to outsource the entire medical billing department in an effort to avoid costly mistakes.

Denied claims not only have a direct financial impact on your practice; they also reduce patient satisfaction. For most physicians, providing the best care for their patients is their primary goal. That not only includes giving them the best medical care but also making their experience an easier one with as few worries as possible. A denied claim that the patient can’t afford to pay will hurt your business immediately and in the long-term as well. They may find other sources for future treatment or forego treatment altogether. All of this can be avoided by verifying insurance and making sure they services you provide don’t end up being a financial burden the patient can’t afford to pay.

External Insurance Verification Can Have Numerous Benefits

Outsourcing insurance verification has proven to be one of the best investments a medical providers can make. The reduction in unpaid claims often becomes evident in a short period of time. Few services can provide the significant and immediate improvement in ROI that prior insurance authorization does.

Healthcare facilities face the challenge of having to submit accurate claims within a specified period of time. When incorrect information is provided or the claim is submitted to the wrong carrier, valuable time is lost. The claim may need to be followed up before the error is discovered. At that point, the entire process starts over again. It the process is not completed correctly within the specified time frame, the claim will not be paid and the claim cannot be recovered. Every time this occurs, you lose cash flow and patient satisfaction is once again put at risk. All of these potential problems can be circumvented through outsourcing insurance verification.

Some of the many benefits include:

  • The ability to streamline your office processes
  • Allows your employees to concentrate on services that can grow your business
  • Provides a reduction in several different risk factors
  • Reduces the amount of effort employees must use to verify insurance and collect on claims
  • Simplifies the workflow of your front desk staff as well as your accounting/billing department
  • Lowers the number of claims that are rejected
  • Reduces paperwork across the board
  • The ability to take advantage of the other healthcare outsourcing services and solutions
  • Billing cycles are faster and easier
  • Delays in payment are minimized improving your cash flow
  • Your staff is more productive and efficient
  • Reduction in time wasted resubmitting claims that were sent to the wrong insurer or with the wrong details

Healthcare is far from being a turnkey business that takes care of itself but your insurance verification can be. The time your staff has to spend on verifying insurance, filing claims, following up, sending out bills, and trying to keep up with payments can all be devoted to the quality of care that you want to offer your patients.

What Else Could Your Employees Be Doing With Their Time?

If you haven’t been taking an active role in the insurance verification processes in your practice, you may be surprised to learn that unpaid claims are having a significant impact on your bottom line. Unpaid claims should be few and far between. All it takes is verifying that the patient has coverage, what that coverage includes, and which insurance company the coverage is with.

If you’re not sure if the outsourcing of insurance verification makes sense for your practice, talk to the person in charge of billing. Ask them how many hours they spend every week responding to denial of claims or responding to requests for more information. Ask them how many hours they’ve spent trying to collect from patients who were incorrectly charged at the time of service due to misunderstandings of coverage or patients deliberately misrepresenting their insurer and/or coverage.

Then ask how much you’ve not been able to collect over the past year due to these issues. If your practice is like many in America, you’ll likely be startled by the answers. There’s no question that your employees could find better ways to spend their time than following up these seemingly tedious – yet incredibly essential – tasks. By outsourcing the verification, billing and collections process, you’ll see numerous benefits and essentialy zero drawbacks. For all types of medical practices of all sizes it’s a win-win situation.

Click here to learn how TrueShore’s Healthcare Outsourcing solutions will benefit your practice.