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5 Reasons to Verify Insurance for Every Patient at Every Visit

6/30/2023

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At Priority Medical Billing, we stress the importance of verifying insurance and notifying each patient of their responsibility prior to every visit. This not only eliminates surprise billing but it will also increase cash flow for the healthcare provider.
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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. Th
is 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 billing@myprioritybilling.com or call 708.362.6080 ext 1001 for more information on the services we offer.   

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Why confirm patient demographics and insurance information prior to the visit?

6/23/2023

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At Priority Medical Billing, Inc, our job is to maximize revenue for healthcare providers.

This is why we strongly recommend that every healthcare providers' office has a policy for confirming patient demographic information, as well as obtaining insurance information at each visit for every patient.

If you are a healthcare provider, and you are not doing this, it will result in financial losses for your office.

When patient demographics and insurance information is NOT collected at every visit, for every patient, your practice revenue can easily be impacted in the following ways.


Missed billing opportunities: Without up-to-date insurance information, claims cannot be submitted in a timely manner and payment is delayed. This can lead to missed reimbursements from insurance companies and a loss of revenue for the practice. Collecting insurance information at each visit ensures that billing can be done promptly and accurately right away.

Inaccurate billing: Insurance coverage can change over time due to policy updates, changes in employment, or modifications to the patient's insurance plan. Failing to collect updated insurance information at each visit can lead to billing inaccuracies. This includes submitting claims with incorrect policy details, outdated coverage information, or invalid insurance identification numbers. Inaccurate billing leads to claim denials and delays in reimbursement.
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Increased denied claims: When a claim is submitted to a terminated insurance policy, it takes time to receive a denial, adjust the account, and request the updated information from the patient. Since insurance companies often require claims to be submitted within specific timeframes. If insurance information is not collected at each visit, there is a higher risk of delayed claim submission or past timely filing denials. This results in increased claim denials, increased patient statement costs, and a possibility that payment will never be received. 

Unpaid patient balances: Verifying insurance coverage also helps in determining the patient's financial responsibility, such as copayments, deductibles, or co-insurance amounts. By not collecting this information at each visit, the practice is missing an opportunity to collect payments from patients at the time of the visit. Unpaid patient balances accumulate over time and can easily result in significant financial losses for the practice. Once a patient walks out the door, the chances of collecting payment drops significantly.

Increased administrative costs: Failing to collect insurance information at each visit leads to additional administrative work. Staff may need to spend extra time following up with patients, contacting insurance companies for verification, or resolving billing errors. This increased administrative burden results in higher costs for the practice and reduced efficiency in revenue cycle management.

Limited understanding of insurance coverage: Collecting insurance information at each visit, and even verifying benefits prior to the visit, allows the practice to have a comprehensive understanding of the patient's insurance coverage. This knowledge enables the staff to educate patients about their benefits, coverage limitations, and any pre-authorization requirements. Without this information, patients may be unaware of their insurance rights and what they are expected to pay after insurance for the service. This can lead to patient dissatisfaction and resistance to paying for the services when they are billed after insurance.

It is crucial for a every healthcare providers' office to prioritize the regular collection, and verification, of insurance information at each visit to minimize financial losses, ensure accurate billing, and maintain a healthy revenue cycle management process.

Here at Priority Medical Billing, Inc, we work with each healthcare provider to help teach them how to implement the best office policies to ensure revenue is being maximized, and patient satisfaction is at its highest. 

For more information on maximizing your revenue please contact us at billing@myprioritybilling.com or call 708.362.6080 ext 1001.  
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7 Steps to Offering Autopay to Patients

6/15/2023

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At Priority Medical Billing Inc, we can assist you in setting up policies, and creating forms needed, to implement an automatic payment processing policy for your patients.  

Setting up autopay for patients is a convenient and efficient method of collecting recurring payments for services provided.

Here are some steps that can help your office to set up autopay for patients:

Establish Autopay Policies: Determine the autopay policies for your practice, including which services are eligible for autopay, the frequency of payments (e.g., monthly, quarterly), and any required consent or authorization from patients. Ensure compliance with relevant laws and regulations, including data privacy and security measures. PMB strongly encourages setting up autopays for all patients.

Inform Patients: Clearly communicate the availability of autopay to your patients. This can be done through various channels, such as your practice's website, patient portal, appointment reminders, or in-person discussions during visits. Provide information about the benefits of autopay, including convenience, timely payments, and potential incentives (e.g., discounts for autopay enrollment).

Obtain Consent and Authorization: Create a process for obtaining patient consent and authorization for setting up an autopay account. This can be done through a consent form or electronically through your practice's patient portal. Ensure that the consent form includes details such as the patient's authorization for automatic deductions, the designated bank account or credit card information, the frequency of payments, and the cancellation process. PMB has these forms and will provide them to our clients at no additional cost. 

Secure Payment Information: Implement strong security measures to protect patient payment information. Utilize encryption protocols, secure servers, and compliance with Payment Card Industry Data Security Standard (PCI DSS) requirements if you're storing credit card information. Alternatively, you can work with a trusted third-party payment processor that specializes in secure payment transactions. PMB works with a trusted third party payment processor to ensure PCI compliance.

Set up Autopay Systems: Depending on your practice's capabilities and preferences, there are different options for setting up autopay systems. You can integrate an electronic payment system into your practice management software, utilize a third-party payment processor, or work with a bank to facilitate automatic recurring payments. Choose a system that aligns with your practice's needs, ensures reliable transactions, and provides detailed reporting. PMB can set up autopay accounts for you within our system, or your office can also set them up.   

Communicate Autopay Schedules and Charges: Clearly communicate the autopay schedule to patients, including the specific dates or intervals when payments will be deducted. Provide an itemized breakdown of charges, such as copayments, deductibles, or recurring fees, so patients understand what they are being charged for.  PMB will also provide a Billing FAQ sheet to be given to all patients explaining the details of autopay for a particular practice at no additional cost.   

Maintain Open Communication: Establish a process to address patient inquiries or concerns related to your specific autopay system. Designate a staff member who can assist patients with any issues, such as updating payment information, adjusting payment amounts, or cancelling an autopay. Ensure that patients feel supported and can easily reach out for assistance.

Monitor and Reconcile Payments: Regularly monitor and reconcile autopay transactions to ensure accurate and timely payment processing. Implement systems to track any failed or declined transactions and promptly follow up with patients to resolve payment issues.  At PMB we monitor all Autopay payments and notify the patients when an autopay has declined.   

Remember to comply with any applicable laws and regulations regarding autopay processes and maintain transparency with patients about their financial obligations. Regularly review and update your autopay policies and procedures as needed to ensure effectiveness and compliance. At PMB, we handle all of this for our healthcare providers so all they have to do is ensure the patient fills out, and signs, the form to authorize the autopay.

If you are looking for a medical billing company to help you maximize revenue from not only insurance companies, but also through patient payments, contact us at billing@myprioritybilling.com or call 708-362-6080 ext 1001 for more information on the services we offer our providers! 

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    Author

    Megan Benzik

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