How to Effectively Deal With Increasing Insurance Coverage Inquiries and Claims

Since there are different comprehensive health plans available like individual policies, employer-sponsored or exchange plans, policyholders often call their insurance providers to inquire about coverage, cancellation, extension or simply clarification about their plan. But in today’s healthcare climate where there is a rise in chronic illnesses coupled with the existing pandemic, many people are apprehensive with their health insurance plans.

And because each policyholder has unique insurance plans, the change in the health economy and the rise of distinct situations brought by health crises, these can cause some degree of confusion to policyholders which in return can trigger them to seek clarifications to their insurers resulting in a surge of inquiries through call, chat and email. To overcome this, here are 2 best ways to effectively deal with surge insurance inquiries and claims.

Employ a great customer service team

Having a great customer service team that can address and respond to these surge of queries helps lighten the load of health insurance companies all the while giving utmost assurance and clarity to policyholders amidst the era of uncertainty. Because with the difference of cost-sharing among plans, it makes sense that people will call their insurance company to find out exactly what is and isn’t being covered. And it is crucial to answer these queries efficiently and effectively especially that there is a significant decrease of policies due to insurance cancellations. This is one way for insurers to retain their existing clients.

To address this, try incorporating several dimensions of your healthcare business supply chain through outsourcing from vendors that have been aiding healthcare companies in the telehealth and health insurance fields. Partnering with third parties like outsourcing companies for patient concierge, medical review specialists and other patient inquiry-related concerns can support production capacity by freeing clinicians from answering phone calls and responding to appointment inquiries. They can also help oversee the day to day peer review process from acceptance of medical cases for review, facilitating first level screening if applicable and preparation of case review documents to be endorsed to doctors, nurses and other healthcare providers. A team of dedicated customer service can focus on answering questions and making sure that these inquiries are responded accordingly.

Incorporate a Dedicated Revenue Cycle Management Team

Increase in inquiries can also result in an increased number of claims or the inquiries are an outcome of some denials. Therefore, having a dedicated RCM team in your business is one sure way to address surge in inquiries and claims. Your RCM team are experts on diagnosis and procedure codes, you are assured that they are to make accurate claims submission that can positively impact revenue cycle. To capture diagnosis codes for billing purposes, the industry uses the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Hence, make sure that your RCM team should have expert knowledge on ICD-10 and CPT coding to yield accurate claims.

Outsourcing your customer service team and dedicated RCM experts ensures that surge in inquiries will be taken care of and any potential issues in claims will be addressed. These teams can also work remotely with the following workout results:

Patient satisfaction
95% coding, billing and documentation accuracy
1 hour turnaround time
Improved denial management rate
HIPAA and DPA-20212 compliance

The right outsourcing partner not only ensure building a great and high-performing Customer service and RCM, it also ensures:

Operational savings of up to 70%
Clinical Documentation Improvement (CDI) and efficient process
Information Security
Maximize revenue
71 Net Promoter Score

Infinit-O is the trusted customer-centric and sustainable leader in Business Process Optimization to Small and Medium businesses in the Financial Services, Healthcare and Technology sectors by delivering continuous improvement through technology, data and people.