Accurate Billing: Verifying insurance coverage ensures that the correct insurance information is on file, including policy details and any changes in coverage. This helps prevent errors in billing and ensures that claims are submitted accurately to the insurance company the first time. Without verification, there is a higher risk of claims being denied or delayed, which can result in billing issues and even financial burdens for both the patient and the healthcare provider.
Patient Cost Estimation: Verifying insurance allows the office to determine the patient's financial responsibility, such as co-payments, deductibles, or co-insurance amounts. This information helps the patient understand their financial obligations upfront and can assist in financial planning for medical expenses. It also allows the office to collect any necessary payments at the time of the visit, reducing the need for later billing or unexpected charges. The best time to collect a patient's payment is always at the time of the vist.
Pre-Authorization Requirements: Some medical procedures or treatments may require pre-authorization from the insurance company before they can be performed. Verifying insurance coverage allows the doctor's office to identify if pre-authorization is necessary, and helps streamline the process by initiating the approval before the visit. This helps prevent delays in treatment, and ensures that the patient's insurance will cover the planned procedure.
Network Participation: Verifying insurance allows the office to confirm if they are in-network providers for the patient's specific insurance plan. Being in-network can impact the patient's out-of-pocket costs, as in-network providers typically have negotiated rates with the insurance company. If the provider is out-of-network, the patient may face higher costs or may need to seek care from a different provider. Just because a provider is in network with a major insurance, like BCBS doesn't mean they are in network with the specific BCBS plan the patient has.
Compliance with Insurance Requirements: Insurance companies often have specific requirements, such as referrals or pre-certification, for certain medical services. Verifying insurance helps the provider understand and comply with these requirements, ensuring that the patient receives the necessary approvals or referrals to access the desired services.
When it comes to insurance companies and the various plans they offer, there is not a "one size fits all" approach to knowing how to best serve each patient. The only way to do this is to verify every patients' insurance at every visit. This is crucial for accurate billing, patient cost estimation, compliance with insurance requirements, and maintaining a smooth financial process for both the patient and the healthcare provider. It helps avoid billing issues, provides transparency in healthcare costs, and ensures that the patient receives the appropriate coverage and benefits according to their specific insurance plan.
If you are wondering why your cash flow is down, Priority Medical Billing, Inc can help you implement an insurance verification process that will work for your office to help maximize revenue, contact us at firstname.lastname@example.org or call 708.362.6080 ext 1001 for more information on the services we offer.