Unraveling The Mystery Of Verification Of Benefits

Before providing any medical services, healthcare providers must first verify a patient’s eligibility and benefits. This procedure ensures that the provider is paid for the services given and that the patient receives the right level of care with no financial surprises. With the ever-changing world of insurance plans, keeping up with the newest rules and regulations can be difficult, making eligibility and benefits verification  a critical element in the revenue cycle management process.

Let’s unravel the mystery of verification of benefits (VOB):

Why is there a need for Unraveling the Mystery?

It is critical for medical practices to do comprehensive eligibility and benefits verification to ensure that patients receive the right quality of care and that they receive correct compensation for services rendered. Here are some of the reasons why eligibility and benefit verification is critical in medical practices:

  • Avoid Claim Rejections:

It is one of the most severe difficulties that medical practices encounter. This is due to erroneous or insufficient patient insurance information. When a claim is denied, it can cause a delay in payment as well as additional administrative expenditures to fix the error. You can avoid claim denials and assure prompt reimbursement for services delivered by undertaking eligibility and benefits verification beforehand.

  • Streamline Operations:

Verifying eligibility and benefits can also assist in streamlining operations and lower administrative costs. Medical practices may minimize errors and save time by automating the verification process and utilizing technology, allowing employees to focus on other vital activities.

  • Improve Cash Flow:

Eligibility and benefits verification can also help improve cash flow by lowering the number of outstanding claims and denials. You can establish the expected payment amount and confirm that you are delivering services that are covered by the patient’s insurance plan by verifying the patient’s insurance coverage and benefits before providing medical services.

  • Increase Patient Satisfaction:

Eligibility and benefits verification can also improve patient satisfaction by minimizing the chance of surprise medical bills. Patients who are told about their insurance coverage and out-of-pocket charges from the start are more likely to be satisfied with their experience and believe they have received fair and transparent billing.

How to Unravel the Mystery?

To unravel the mystery of VOB, you should ensure the following best practices:

  • Electronic And Manual Eligibility Verification Processes

Most payers have made online eligibility checkers available. By electronically checking eligibility before the scheduled patient appointment, you will be able to:

  • Obtain correct information about the patient’s insurance status and comprehend the health plan’s benefits.
  • Determine whether or not you must collect a copay at the time of service.
  • Update details about insurance
  • Request the patients to update their primary care physician credentials.

It is sometimes necessary to contact the payer with inquiries about prior authorization services requirements or to clarify specific eligibility and benefits elements.

  • Timeliness of Eligibility Checks

At least 48 hours before the appointment, healthcare providers must check eligibility. If this is not possible, it can be done in real time before the treatment during check-in. Timely eligibility checks aid in the reduction of claim rejections and denials. Electronic eligibility checking is available in most electronic health records and revenue cycle management systems. Your medical practice will be able to reduce denials and boost revenue realization by validating the patient’s coverage before treatment delivery.

  • Process Documentation Importance

Your practice’s requirements are unique. A substance abuse treatment center’s eligibility verification requirements are quite different from those of a hospital or radiology clinic. As a result, each healthcare provider must develop its own eligibility and benefits verification protocols. All members of your team must work together successfully to guarantee that all steps are completed efficiently.

  • Checklist for Eligibility Verification

The following are some of the points in the checklist for determining patient eligibility and verifying benefits:

  • Check to see if the plan is still active.
  • Always inquire about any upcoming or recent insurance changes with the patient.
  • Check if the patient has primary, secondary, and tertiary insurance. Ascertain that the patient’s Coordination of Benefits (COB) with each payer has been updated.
  • As a significant segment of the population in the United States ages, check Medicare coverage for patients over the age of 65.
  • Confirm if the patient’s insurance policy covers the procedure.
  • Some plans may limit the number of visits and time frames in which medical services can be provided and the benefit limits. These details must be obtained through the front office.

Outsourcing Verification of Benefits to 24/7 Medical Billing Services!

It is critical for a medical practice to ensure proper reimbursement and revenue cycle management. Surprisingly, eligibility and benefits verification are critical Revenue Cycle Management (RCM) components. It can, however, be a time-consuming and intricate task requiring substantial resources. This is where outsourcing verification of benefits can assist.

24/7 Medical Billing Services recognizes the importance of eligibility and benefits verification in your revenue cycle management. That is why the entire team provides the best solution to assist your medical practice in ensuring correct reimbursement while focusing on patient care.

In fact, practices can increase cash flow, cut costs, and focus on core businesses by using the skills and knowledge of specialist service providers. To protect your practice’s financial sustainability, exploring outsourcing as a feasible alternative for eligibility and benefits verification is critical.

See also: Healthcare Billing: Simplifying Complex Medical Reimbursements

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