One of the most common mistakes in medical billing is the failure of accurate verification of insurance claims. Insurance verification is the topmost significant step in the medical billing and coding process. Before you provide midwifery care to your clients, you have to verify if the patient’s healthcare benefits will cover up all the medical procedures needed. Presently, the healthcare industry continues to shift into many complex settings that require closer attention in validating insurance coverage, patient benefits, deductibles and copayments.
Every successful billing merely depends on the success of eligibility verification. In a brief summary, health insurance verification is the process of checking a patient’s active coverage with the insurance company. It also verifies the eligibility of a patient's insurance claims. Checking your patient's insurance benefits BEFORE the patient is seen should be a fundamental part of your practice's administrative process. Otherwise, you run the risk of claims being denied and left unpaid. You don't always have the right to appeal or bill your patient which is why it is so important to know the patient's insurance benefits before treatment begins.
When checking benefits, be sure to ask the right questions.
1. What is the patient's financial responsibility?
2. Does this patient have visit limits?
3. "Is this a plan year or calendar year?"
4. "Is a referral or authorization required?"
If your administrative process does not include checking patient benefits before the patient is seen, your revenue cycle management is hindered from the start. Accurate insurance verification ensures a higher number of clean claims which speeds up approval and results in a faster billing cycle. Inadequate verification of eligibility and plan-specific benefits puts healthcare organizations at risk for claim rejections, denials, and bad debt. Always pay attention to the documents submitted and be scrupulous in receiving the data needed for your service reimbursement.
Ramsey, D. (n.d.). The 5 most important questions to ask when checking benefits. Account Matters Blog. Retrieved August 5, 2022, from https://blog.accountmattersma.com/5-important-questions-to-ask-when-checking-benefits