Insurance claim denials catastrophically affect infusion centers’ revenue cycle management (RCM). The American Medical Association (AMA) reported that some significant commercial payers encounter a claim denial rate between 1.63% and 9.6%, which can reach 23%. Payment delays and claim denials create additional costs for infusion centers, disrupting the entire revenue cycle.
Here is where eligibility and benefits verification services come into play. These services boost accurate billing while ultimately covering financial losses. The verification confirms a patient’s coverage while identifying the underlying limitations before administering treatment.
So, how exactly do eligibility and benefits verification services improve your compliance mechanism? Read further to know more.
Eligibility and Benefits Verification in Infusion Centers
Infusion therapy clinics cater to patients’ bloodstream requirements, hydration, and other essential medical administration requirements. In most cases, expensive infusion treatments are prescribed to patients, which can strain a clinic’s revenue cycle if not covered under insurance.
How Does Insurance Claim Denials Lead to Bad Debt in Infusion Clinics?
- Disruption of revenue stream: If an insurance claim is denied after administering an infusion service, the clinic will not be reimbursed for the costs associated with the service. Severed cash flow or a disrupted revenue stream leads to unrecoverable costs or bad debts.
- Patients incapable of paying upfront in claim denial events: Patient parties might not be capable of reimbursing an infusion facility with out-of-pocket charges on a particular claim denial event. The unpaid balance amount becomes an unrecoverable cost for the facility.
Need for Verification of Eligibility and Benefits Process in Infusion Clinics
- Prior authorization checks: Several infusion treatments are costly, which require infusion clinics to seek prior authorization from insurance companies. Prior authorization from insurance companies is to reduce the probability of claim denial while securing cash flow and preventing bad debts.
- Chalking out the treatment plan: Knowledge of the coverage details supports an infusion clinic in identifying the most suitable treatment options. Treatment aligned with and covered under the patient’s insurance plan improves cash flow. It also assists in reducing the scope of claim denials and improving RCM.
- Accuracy of patient billing: Outdated and incorrect information leads to claim denials. Verification of eligibility and benefits covered under a patient’s health insurance plan allows IV therapy centers and infusion therapy clinics to issue appropriate invoices to insurance companies, reducing instances of claim denials. Moreover, verification practices are crucial to complying with healthcare regulations related to patient billing and insurance coverage.
Process for Verifying Insurance Eligibility and Benefits
A precise verification of the patient’s eligibility factors, like coverage of prescribed treatment under the current health insurance plan, deductibles, and policy coverage limits, is integral. It enables practitioners to design the treatment process efficiently while adhering to the policy coverage. For example, a patient seeks ambulatory infusion care, but the health insurance plan does not cover the expenses. An ambulatory infusion is far more cost-intensive than general infusion therapies as it involves specialized staff to handle complex infusion regimens outside a care facility. The probability of claim denial is almost certain if an outpatient infusion service provider fails to verify the insurance plan coverage, eligibility, and benefits. Therefore, a systematic verification process is essential for validating the insurance eligibility and benefits covered under a patient’s insurance plan.
- Patient information: The step includes gathering patient-centric general information from the insurance card or document. It is a stepping stone for identifying policy coverage, benefits, and eligibility for policyholder insurance plans.
- Comparison of patient information with insurance plan: At this stage, the service provider compares and checks the general patient information with the insurance plan. This helps validate whether the patient and the policyholder are the same entity.
- Data validation and authorization from the insurance company: Patient data validation and seeking authorization from the insurance company are crucial steps for verifying the co-pays and deductibles while designing the treatment options. This stage largely supports seeking approval from insurance companies and reducing instances of claim denials.
- Communication with the patient: At this stage, the service provider interacts with the patient and makes the same aware of any additional or out-of-pocket costs that might be incurred by the patient party if not covered under the insurance plan. The stage supports seeking consent from patients on their pertinent payment capabilities before proceeding with the treatment.
- Updating patient records: As a last step, patient records are updated with the validated information. The step assists in processing accurate billing, an essential strategy for avoiding claim denials.
Are you finding it hard to manage patient care and the entire verification process single-handedly?
You can get assistance from a professional Eligibility and Benefits Verification Service provider.
Path of Compliance for Infusion Clinics: Eligibility and Benefits Verification Services
An Eligibility and Benefits Verification Service provider assists by:
- Generating accurate medical billing that sorts out misinformation, which, could have led to claim denials
- Using automated verification systems that reduce administrative workload
- Improving cash flow through efficient patient responsibility communication
An infusion clinic aims to improve patient experience and gain economic stability thereby. The insurance eligibility and benefits verification services reduce the chances of disrupted revenue or bad debts in an infusion clinic through neat medical billing.
Furthermore, trusted verification services enable a care provider to fully understandterms, coverage, co-pays, and deductibles before conducting an infusion therapy. In any case,Ifnt is not covered under an insurance policy, clear communication that is powensurance eligibility and benefits verification allows practitioners to obtain consent from the patient. It assists iThisensuring transparency and making patients aware of how much they need to pay out-of-pocket, complying with the latest healthcare billing regulations.
Therefore, the entire purpose of the verification services is to promote patient satisfaction, ensure a continued revenue stream, and ensure compliance.
