Successful billing depends on successful insurance eligibility verification. That is why healthcare businesses should put enough importance on insurance verification services because it plays a major role in hospital’s claims denial management program. Basically, health insurance verification is the process of checking a patient’s active coverage with an insurance company to verify insurance claims eligibility.
Simple errors such as patients providing wrong or outdated information or when insurance policies were terminated or modified which can result in claim rejection or denial, hence hospitals and healthcare businesses have to be sure it is being done correctly. The verification process must be done before the patient is admitted into a hospital to avoid claim rejection at the on set. That is why it is crucial to employ a team of Insurance Verification Specialists in your organization. But some challenges such as high labor cost and access to certified experts makes it difficult for businesses to create their own team. But having them contributes to the following:
- Minimize Denials and Maximized Revenue
A team of insurance verification specialists play a big role in completing paperwork and verifying patient information with the insurance carrier to maximize reimbursement and facilitate revenue cycle improvement. They verify the following:
- Payable benefits
- Patient policy status
- Effective date
- Type of plan and coverage details
- Plan exclusions
- Claims mailing address
- Referrals & pre-authorizations
- Lifetime maximum, and more
If those things are verified correctly, it minimizes denials which ensures that claims are processed correctly, payments are received accordingly and locks in revenue for the business.
- Helps Avoid Business Risks
When finalizing the medical bills of patients, health insurance should be done correctly. If implemented in a wrong way, it could result in decreased revenues. Insurance verification performed by a team of Insurance Verification Specialists helps the business to know immediately whether the insurance provider can pay the respective charge for the patient’s treatment or not. In return, they can inform the patient with the treatment plan and payment criteria beforehand and avoid any confusion on their end and unpaid treatments. Lastly, they avoid claims rework which is counter productive and is cost incurring for the operations. In return, this improves billing cycles with decreased denial of claims and leads to an overall development of healthcare practice.
- Simplifies Claims Process
Healthcare businesses prefer a smooth and aligned work process. These days healthcare billing companies make sure that the verification is performed and completed in a simple yet hassle-free manner which allows medical professionals to then work with ease and stop worrying about the payments if you have a team of dedicated Insurance Verification Specialists in your organization. On top of it all, they liberate your core-medical team from the unnecessary paperwork. This means they can solely focus on their specialization without worrying about the charges and other clearances from patients.
Although, building a team of Insurance Verification Specialists can be costly and challenging to find those that are qualified. But the right outsourcing partner can meet your insurance verification demands. Make sure to look for a partner that has:
- Industry Experience and Expertise
There is no substitute for experience in outsourcing, so make sure that before choosing a partner, check for a proof of positive track record of industry & domain expertise, number of years they have been offering these services, and client partnership tenure and company reputation & success rates such as Net Promoter Score (NPS). In line with this, they should also have the right expertise and knowledge when it comes to such a sensitive sector that is healthcare in order to render services effectively. As an example, Medicare claims processing is something that can be difficult to build internally, but is the exact skill that an outsourcing provider specializing in medical billing excels at. This can result in significant increase in collections.
- Access to World-Class Quality Talent
Another thing to factor in when choosing a healthcare BPO is its range of services, from billing, coding, clinical documentation, telehealth services, and more, it would be best if you go for a one-stop provider as this will save you from the trouble of working with different providers for different services. At the same time, dealing with one company enhances overall efficiency and accuracy.
Good providers also insist on building a dedicated team of highly-experienced healthcare professionals who can deliver quality results. You may want to look for one that houses talents with the skill and experience necessary to adapt the current technology you are using and be able to continuously improve on it. Usually, a great partner has A+ recruitment team and process who has access to world-class talent despite the competitive talent pool and can project a 70% operational cost savings.
- High Net Promoter Score
Net promoter score helps businesses gauge the quality of the customer service offered by outsourcing companies. Organisations can use NPS to assess which outsourcing service is best to partner with because this score shows loyalty trends and growth revenue outputs.
In a way, NPS represents the primary way customers survey their experience because it means that their clients are happy which results in customer loyalty and retention, making this a critical trait a BPO company should have. When used correctly, NPS (of at least 60%) can tell you how well the BPO is performing, how often they resolve issues, and if their clients are satisfied with their experience.
All these qualities and more can be found with the right outsourcing partner who can provide a customized, high quality healthcare business solutions that can promise for the following:
- Operational excellence
- Build a great Insurance Verification Specialists & RCM team
- Prevent claim submission errors and rejections
- Improve business revenue
- Operational cost savings of up to 70%
- 90% Improved denial management rate
- ISO 27001 and 9001 certified, GDPR, HIPAA compliant
- Net Promoter Score: Sense of security and peace of mind
Partnership with Infinit-O
Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.
Infinit-O Key Benefits:
We can build you a great, high-performance Revenue Cycle Management team composed of:
Patient Support Services
- Insurance Verification Specialist
- Patient Concierge Specialist
- Collections Specialist
- A/R Specialist
Provider Management Services
- Medical Coders
- Medical Billers
- Claims Processors
- Enrollment Processors
- Denial Management Specialist
Health Analytics and Risk Management Services
- Healthcare Analyst
Start small. Exceed expectations. Think infinitely. Think Infinit-O.