3 Misconceptions that Cause Financial Losses in Healthcare Insurance Verification

There are several misconceptions in healthcare that lead to substantial financial losses. Unfortunately, as a result, many healthcare providers experience payment delays, denials, rejections or even write-offs from inaccurate information and inefficient procedures in the claims reimbursement process.

Misconception #1) Finding Insurance = Getting Paid

Finding insurance doesn’t always mean you’re getting paid. You may still be hindered by several factors that cause delays in payment submission and collection. These include High Deductible Health Plans (HDHP), post Explanation of Benefits (EOB) for patient’s responsibility, delayed claim submission and collection processes. If there are errors within the process of healthcare insurance verification, this can lead to claim denials, rejections and payment delays.

Misconception #2) All Data is Created Equally

How accurate is your patient data? Is your current solution using the most accurate, real-world, real-time patient data for healthcare insurance verification? Stale, inaccurate, or even missing patient data will disrupt in the reimbursement process.

Accuracy and quality vary and rely upon the following:

• The freshness and accuracy of your input data

• How you enter the initial data into your system

• The delay between care/test and validation

• The accuracy rate of your validation method

  • Public ID -vs- Payer-maintained ID

  • What data sources are queried?

•  The delay between validation search and validation received
  

Misconception #3) Automating Operations Requires an IT Overhaul and Huge Investments of Time and Money

Automation is key to creating an efficient workflow and prevent billing errors from manual data entry. By utilizing solutions such as intelligent verification, you can avoid these hurdles with the following:

• Affordable solution and quick to implement

• Easily integrates into your workflow at multiple points

• Directly embeds into / communicates with your existing information system

• DOES NOT require hardware or software purchases, nor ongoing maintenance 

How much are these misconceptions costing you?

Questions to ask and determine if your current solution is providing the best results:

1. Are you able to get critical demographic and eligibility information on a patient you have never seen, directly within your system?

2. Can you get that information using just a name and zip code, or by scanning a driver’s license?

If you answered No to either question above, you may want to reconsider your healthcare insurance verification process.

What does this mean for your workflow?

Common workflow inefficiencies that create substantial burdens on labor, time and cash:

• Order Entry

  Manual order entry is time consuming and prone to keystroke errors. This causes delays in both payer and patient billing. If there is no validation prior, the eligibility and ID data is often outdated. Insured self-pays are not identified early enough and uninsured patients are often not identified at all. This will cause delays as well and less collected.

• Billing: Claim Handling

  • Identity validation:  minimal or non-existent
    Public ID -vs- Payer-Maintained ID

  • Benefits validation

    • Manual
      Time waste & error prone (keystroke errors)

    • Electronic
      30%-40% inaccurate (industry average)

    • Standard batch/bulk processing

    • Creates delays (waiting for files)

    • Can require IT person

• Billing: Claim Rejection Cycle

  The rejection cycle can cause delays and increase costs in the reimbursement process including:

  • Timely Billing Transparency: Patient hit with an unexpected bill

  • Timely Communication Methods: Paper bills, often 60-90 days after care/test

  • High Costs from paper payment

How to Cut Costs and Manage Margins?

To reduce costly errors and create an efficient operation for your healthcare organization, follow the 5 steps below:

1. Eliminate manual data entry and manual validation

2. Validate the patient’s identity, real-time, every time

3. Use ONLY real-time, accurate, electronic data early in the process (before or at care/test)

4. Start accounts receivables procedures early (at or immediately after care/test)

5. Make it easy and automated for customers to pay

By creating an automated workflow for healthcare insurance verification, you will experience a smoother and faster reimbursement process. This will increase the performance and financial benefit for your healthcare organization while boosting front line staff productivity and improved patient experience.