Generally speaking, regardless of how big your medical practice is, managing all of your day-to-day operations in-house can easily start to get a bit overwhelming – that said, one area where there’s no room for error is how you handle insurance information.

Of course, it goes without saying that collecting and verifying patient insurance data can end up being pretty complex, but if you want to receive proper reimbursement for the services your practice provides, it’s not something you want to be blasé about.

Why Accurate Insurance Information Matters

Put simply, having accurate insurance information for all your patients is what gets your practice paid in a timely manner – something that’s obviously of great importance when you don’t have the cash flow some of these larger practices might have.

If you don’t have the correct details for any given patient’s insurance coverage, your practice may end up facing the following:

 – Delayed payments

 – Rejected claims

 – Financial losses

As such, verifying insurance eligibility before or even during a patient’s visit is something that’s going to help you avoid all of these complications – not to mention that it makes both you and your patients clear about coverage expectations.

Aside from this, verifying patient insurance early in the process is generally just beneficial when it comes to being transparent with your patients – once they actually know the extent of their coverage, it’s way easier for them to plan for any out-of-pocket expenses.

This might seem like a fairly small detail, but if your patient ends up with some expenses you didn’t let them plan for, there’s a slim chance they’ll ever want to visit your practice again in the future.

Sources for Collecting Patient Insurance Information

Fortunately, there are actually a few ways that you can choose from when it’s time to collect patient insurance information:

1. Directly From the Patient

In terms of simplicity, your best bet to verify insurance information is just by asking the patient themselves. If you don’t already have this kind of system running within your practice, all you need to do is ask the patients for their details while they’re scheduling – or even during – their next visit, including:

 – The insurance company

 – Policy number

 – Group number

Again, it’s obviously going to be a bit quicker if you do this via an online form, but it’s also your job to ensure that all the information they’ve provided is fully accurate and complete – so it might be worth making a copy of the insurance card so that you avoid any human errors from manual entry.

2. Insurance Provider Websites

After you’ve collected that data, you then just need to verify patient insurance through their insurance provider’s online portals. This sounds a lot more long-winded than it actually is, though, since the majority of insurance providers out there offer online tools where healthcare providers like yourselves can:

 – Access a patient’s insurance coverage information

 – Check their policy status

 – Confirm eligibility

It can definitely be a bit tempting to skip this step, but you genuinely can never rely on the patient consistently providing up-to-date details – especially if there have been recent changes in their coverage.

Again, we appreciate that navigating these websites can be a bit time-consuming at times, particularly if your staff is juggling multiple patients, but insurance provider websites are often reliable so it’s just a process you’re going to have to go through in order to avoid billing issues later.

3. Third-Party Clearinghouses

Furthermore, third-party clearinghouses are something you might want to look into as a way of obtaining patient insurance information – these are essentially just intermediaries between healthcare providers and insurance companies, so this gives you a way to submit and verify claims electronically.

That said, using clearinghouses for the whole insurance verification process is generally something you’d only want to do when you’re handling large volumes of patients. There’s obviously the whole cost element that comes with this, too, so all in all it’s not the simplest of solutions out there.

Partnering With PMN for Better Insurance Management

Given the complexities you face when you need to verify insurance eligibility, you’re far better off working with a professional medical billing and coding service like PMN rather than investing in EHR systems or clearinghouses. Among a list of other things, handling the insurance verification process is something that we specialize in here at PMN, so we’ll also ensure that your claims are submitted both accurately and on time.

Our team has over 20 years of experience in handling insurance eligibility verification, so whether it’s managing all the intricacies of different insurance providers or speaking with patients directly, we’ll massively reduce the likelihood of your practice facing a claim denials or delay. Then, all that’s left for you to do is get back to your patient care since we handle all of the administrative tasks.

Aside from this, the range of services we offer goes far beyond just verifying insurance eligibility – we also provide comprehensive medical billing support, including things like:

 – Claim submissions

 – Follow-ups with insurance companies

 – Resolving rejected claims

If you’d like to hear more about the types of services we have here at PMN, don’t hesitate to get in touch today by calling at (949) 215-5055. We definitely appreciate how most healthcare providers would prefer chatting about this sort of thing face-to-face, though, so if you’d like to schedule an appointment on our website, we can have an in-person conversation at our office in Laguna Hills, Orange County, California.

FAQs

Why Is It Important to Verify Patient Insurance Eligibility Before an Appointment?

Simply just so that you can confirm the patient’s coverage details and reduce the risk of any potential claim denials, which are obviously going to set you back a bit when you’re running a small practice. This then allows you to:

 – Avoid delays in payment

 – Minimize billing errors

 – Give patients a clearer understanding of their financial responsibility

What Happens if Patient Insurance Information Is Not Accurate?

As a healthcare provider, if the insurance information your patients provide you isn’t accurate, you’re running the risk of claim denials or delays in reimbursement, which is then going to create a lot more administrative work in order to resolve any issues with the insurance company.