Benefits verification, prior authorization, and verification of pre-authorization are imperative procedures at all healthcare facilities.
You can either cause revenue leakage and strain your relationships with patients or maximize your profit and build excellent relationships with them based on how well you perform these procedures.
Benefits verification, prior authorization, and pre-authorization verification can be made easier and less stressful in a few different ways. Look at them down below.
Benefits verification
Checking a patient's active insurance coverage and benefits with an insurance company before various procedures are known as benefits verification. This is done to ensure reimbursement.
Common benefits verification terminology
Let’s define some terms generally during the verification of insurance benefits.
- In- network
- Out-of-network
- Allowed amount
- Coinsurane
- Out-of-pocket costs
- Copayment
- Deductible
- Out-of-pocket maximum
- Claim
Why is it important to verify patient benefits?
The first and most important step in revenue cycle management is verifying insurance benefits. The claim submission process runs more smoothly when verifications are completed correctly and on time. This improves the facility's financial security by reducing the number of denied claims and maintaining a steady cash flow.
When calling a patient's insurance company, a facility may provide incorrect information if it does not have an effective method for collecting, storing, and updating the patient's information. A claim rejection is what happens next, which is all too familiar. Resubmitting a claim is a time-consuming and resource-intensive process.
In addition, because you can inform patients about how much they will have to pay for services before they are rendered, an effective and proper benefits verification process can significantly increase patient satisfaction. Patients are more likely to arrive prepared to pay or to have a payment plan in place if they are informed of the cost in advance.
Patients have difficulty understanding their financial responsibilities as a result of an ineffective insurance eligibility verification process, necessitating the transfer of unpaid accounts to collections. In the end, this may lead your patients to become dissatisfied and seek alternative medical attention. Read more about benefits verification, prior authorization, and verification of pre-authorization processes
