by Ray Foxworth, D.C., FICC, MCS-P

President & Founder, ChiroHealthUSA

In last month’s newsletter, I discussed the pervasive problem of insurance claim denials and how to minimize them. One goal of that article was to get you all to ask one question. Does my practice have an effective insurance verification process?

If not, you’re surely feeling the pain. Studies show that health care providers lose $125 billion per year in faulty or inefficient billing practices. And with insurance claim denials being a major part of that, it’s worth noting that two of the top five reasons for claim denials were related to insurance eligibility.

So, in a time of ongoing stress and chaos in the chiropractic profession, the stakes are high. Here’s what you need to know to tighten up your insurance eligibility verification process and minimize the billing leak.

What Does Insurance Eligibility Involve?

Insurance eligibility verification is the process of determining a patient’s:

  • Coverage status
  • Active or inactive status
  • Eligibility status

A practice that fails to perform such verifications will inevitably see the process of providing care break down. Claims will be denied. Payments will be delayed. Patients will be needlessly frustrated and they will take it out on your staff and your practice.

Steps for Insurance Eligibility Verification

Here is one service’s thorough step-by-step process of insurance eligibility verification, and it serves to show the detailed information required:

  1. Get patient demographic information from referral sources such as a hospital, clinic, or from the patient directly.
  2. Verify the patient information with the carrier, including:
    • Payable benefits
    • Co-pays
    • Co-insurance
    • Deductibles
    • Patient policy status
    • Effective date
    • Type of plan and coverage details
    • Plan exclusions
    • Specific coverage
    • Claims mailing address
    • Referrals and pre-authorizations
    • Lifetime maximum
  1. Verify the patient’s coverage on all primary and secondary payers.
  2. Update patient accounts.
  3. Communicate with patients and complete paperwork.

As you can see, it’s a detailed process. So many practices are left asking themselves whether this is more than they should be putting on a staff that might be overburdened already.

Should You Outsource?

For those looking for a different option, there are numerous companies and software packages that will handle this burden for you, and often they will include insurance eligibility verification as part of a comprehensive medical billing service. They all promise to provide expert professionals or software that will streamline billing, eliminate errors, minimize claim denials, and ultimately, give your practice a more efficient and more profitable financial outlook.

If you decide to go this route, just be sure to do your due diligence by checking to make sure you’re choosing a reputable company that can back up its promises. The right company or software can make a big difference in turning a frustrating, labor-intensive process into an effective tool that reduces costs, improves cash flow, increases patient satisfaction, and allows you to focus on what you’re there for: to provide great patient care for everyone who walks through the front door.

If you are looking for more guidance on whether or not outsourcing your billing is right for you, what questions to ask when looking for a company, and more, join us on July 28, 2020, for the webinar  “Outsourcing Billing: Is it Right for You?