Help Medical Practice Staff Navigate the Insurance Verification Maze

June 29, 2013

Here are tips to overcome the misinformation and runaround your medical practice staff often gets when verifying insurance to get closer to an accurate payment.

Regardless of your source for information, the insurance verification process has many, many variables. Insurance companies often push your staff to verify benefits on their website, rather than call up their customer service representatives. The problem with insurance company websites is that they are not always up to date regarding patient deductibles or out-of-pocket amounts. The website also may not share if the patient has a Health Savings Account (HAS) / Health Reimbursement Account (HRA), or other specific benefits tailored to your niche practice.

Using companies like ZirMed will let you know quickly if the patient has benefits, and is eligible for specific services. They may or may not be up to date with specific amounts as well, but provides this information in less than a minute in most cases. If you call and actually get to speak with a payer representative, you are running the risk of so many areas of misinformation. Some of these reps are not even in the same country you are and have no idea what type of plan the patient actually has. Each plan is so different, and if you are looking for specific information, it may be delivered incorrectly based on the type of office you have (in-patient, out-patient, private practice, hospital affiliated, etc.) These phone calls can take anywhere between five minutes to 30 minutes per call.

So, with all of these confusing options, which is the best route?

1. The quick but not very specific.

2. The website you have to sign up to be a part of, and the information is not updated.

3. The lengthy and perhaps misinformed phone call.

You have to remember than one of the reasons you verify patient benefits is to be able to collect properly from them at the time of their visit. Explaining the benefits to the patient and collecting the correct amount is a fantastic customer service experience for them.

Weighing all of the risks versus rewards is where you need to begin. Does your staff have the time to be on the phone for long periods of time, while checking the website for additional benefits? The combination of the two might be helpful. If the quick but not very specific way is the only route you have time for, consider looking at how the date of service paid once the insurance company has processed the visit. You can always send the patient a bill, if needed. Keep in mind that this is more administrative time spent on the back-end instead of the front-end.

I've said in previous blogs that it's a good idea to get the patient involved. Why not "invite" the patient to call up their insurance company and ask them what their benefits are if they came to see you? That way when they arrive, your front office staff and your patient can share what they have learned. Some of it might be the same, some not. Either way, when the insurance processes a claim differently than what your staff was told, the patient can already have a perspective that this type of courtesy is not exact, and that the variables involved are so great.

Regardless of the process you choose, just keep in mind that human error is a major factor on so many levels when verifying insurances. You cannot hold your front-office staff entirely responsible for misinformation. Just keeping an eye on how the claims are paying will help the learning curve, and you may be able to spend less administrative time with this type of task.