Insurance Verification and Your Practice

Sep 02, 2022
Article Background

Medical billing and insurance eligibility can be difficult to understand, which means many patients and providers may feel lost while navigating patient needs and payment options. Insurance verification can provide important information and peace of mind for patients, providers, and payers.

Many patients do not fully understand medical billing and their health insurance benefits. They may not understand what treatments and procedures are covered. Healthcare providers also have questions about patient eligibility. At a time when hospitals and healthcare workers are struggling to bounce back from revenue hits caused by COVID-19, uncompensated medical treatment is an additional blow to cash flow. Insurance verification is the process of verifying health insurance benefits that can assist providers, payers, and patients.

Insurance Verification Basics

Health insurance is complicated. Many patients are unaware of the extent of their insurance coverage and benefits and may refuse needed medical care due to this lack of knowledge. In contrast, providers and medical billers may be uncompensated or write off medical bills from patients who either don’t know or don’t provide insurance information. Further complicating matters, patients have become healthcare consumers and can easily change providers if unsatisfied with their treatment or billing experience. It’s clear that sorting out the medical billing and insurance component early will benefit both the patient in need of care and the provider in need of coverage guidance and compensation.

Insurance verification allows providers and payers to find unknown insurers and co-insurers such as Medicaid or Medicare. It’s a difficult and time-consuming process, but it can transform the consumer-patient experience. All it takes is the right tools.

woman on the phone

Challenges of Insurance Verification

Insurance coverage is complex and changes throughout a person’s life, based on their personal status, network, choice of provider, and eligibility for Medicaid or Medicare. It’s important that providers, medical staff, and insurance payers run insurance verification at various stages: pre-service, during registration, and post-service.

Recent data from the American Hospital Association shows more than $660 billion in uncompensated patient care in U.S. hospitals since 2000. Further, data shows that in 2019 alone, underpayment by Medicare and Medicaid resulted in a deficit of $75.8 billion. These figures mark a significant challenge not only for providers and payers, but for patients as well. While uninsured patients contribute to some of the payment challenges, the U.S. Department of Health and Human Services recently released a report indicating the national uninsured rate dropped to an all-time low of 8% this year. Under these circumstances, verifying insurance is even more important for identifying eligibility and securing reimbursement from the appropriate sources.

Manually searching for and verifying insurance is not only labor- and time-intensive; it’s also not scalable or sustainable over the long term. It creates unnecessary stress and places a burden on the medical billing staff to identify the primary, secondary, and even tertiary coverage for each patient. To make matters worse, they must complete this manual verification quickly and accurately to ensure they are able to bill the appropriate payer. Mistakes can lead to reimbursement delays or payment denial, further complicating the reimbursement process.

With a comprehensive price transparency solution that automates the insurance verification process, medical billing teams can easily identify the right payer to invoice and secure more payments than they could on their own.

female medical professional working on a computer

Choosing a Solution

An insurance verification and follow up solution can make the process of verifying insurance information much easier for providers and payers, but finding the right solution in a sea of options takes time and diligence. A few questions to ask during the selection process include:

  • Does the vendor have experience in this sector?
  • How long has the company been in business, and does it have any reviews or recommendations from other clients?
  • Is the software easy to learn and implement?
  • Will the software integrate well with electronic records?
  • What type of fee structure (e.g., unlimited, time limits) does the vendor offer? Does it provide a money-back guarantee?
  • What is the solution’s percentage of successful insurance verification searches?

Understanding insurance coverage, treatment eligibility, and patient liability estimates is the first step toward ensuring prompt and complete payment for services. With TruBridge, providers and payers gain increased visibility into patient insurance coverage, whether the patient is aware or not, and enables them to have constructive conversations with patients about their options. Additionally, TruBridge supports remittance management to help secure payments without the headaches.

We can help you learn more about insurance verification and remittance management.