What is insurance verification? It's the process of checking a patient's coverage with an insurance company to verify the eligibility of their claims.
Getting paid is never guaranteed, and having a poor process for verifying patient eligibility is a sure way to not receive payment for your services. Fewer denials means faster payment and more time spent on optimizing your billing rather than fixing preventable problems.
Our four recommendations
- Create a template for verifying insurance
- Track your verifications in Fusion
- Verify insurance before seeing a patient for the first time
- Decide on a cadence for regularly re-verifying insurance
Create a template
On the surface, verifying insurance is as simple as getting the patient's effective coverage dates. In reality, there is definitely more to it. Guarantee all the right questions are asked by having a form or checklist you or your staff uses for every verification. We've found this Coverage & Benefits Verification Questionnaire is a great place to start. Download it for your team and tweak it to match your process.
Did you know? Statistics show that up to 75% of denials are for ineligibility.
Track your verifications in Fusion
When a claim is denied, the first action our Assisted Billing team takes is to verify your team has recorded the patient's eligibility information. Tracking verifications in Fusion and uploading your completed verification form into Fusion for each patient saves everyone involved a lot of time. Less time spent here means more time spent focusing on your overall billing health. Check out both help articles below for info on tracking verifications in Fusion:
- Patients: This article reviews every section of the patient profile. Verifications are tracked in the Payers section.
- Verification Reminders: Fusion can remind you to verify a patient's coverage based on the information you add in the patient profile. Check out this article out for a crash course on verification reminders.
Verify before treatment
When a patient calls to schedule an appointment, you should always discuss payment and insurance coverage with them. Waiting for the patient to arrive for their first visit is too late and one of two things will happen:
- Best case: The patient brought their insurance card, has coverage for the intended services, knows their copay, and arrived prepared to pay their portion before treatment.
- Worst case: You find out after rendering services that the patient isn't covered, isn't willing to pay, and your team offered an hour or more of free services.
Pro Tip: Being intentional before the patient arrives sets your patient's up for a great experience and your practice up to get paid for it's services.
Decide on a cadence for re-verifying
Regularly re-verifying insurance is essential because patient coverage can change at any time. If you don't have a process for re-verifying, you're relying on your patients to tell you. Tip! They won't always tell you. We recommend asking your patients if there has been any change to their coverage at every appointment. If there has been a change, go through the processes of verifying before providing services.
Pro Tip: Most coverage changes aren't predictable, but coverages frequently change at the beginning of a new year. Be particularly vigilant during the first few months of each year and double check with your patient's about their coverage.