Coronavirus or the novel COVID-19 disease has affected millions of people across the world. The communicable disease is caused by a family of viruses that results in acute respiratory illnesses, such as impaired lung and kidney functions, pneumonia, and even multi-organ failure. Across the globe, there has been a closure of businesses as well as the loss of jobs and lives. The general economic situation is a global recession.
Hence it is vital to know the importance of insurance eligibility verification during COVID-19:
Impact of COVID-19 on Health Insurance Industry
The coronavirus (COVID-19) outbreak is causing extensive concern and increasing economic suffering for businesses, consumers, and communities. It is hard to determine the impact on health insurance on a global scale because the impacts will be very different country by country. But the consensus is that the COVID-19 pandemics has put a lot of stress on the already under pressure health insurance market. An increase in health claims has been the most obvious effect of COVID-19 on the insurance industry.
The number of people eligible for Medicaid has increased drastically. Again, this stems very directly from job loss, as well as from employers deciding that they can’t afford to continue to offer health insurance, which is another reason why people sometimes end up on Medicaid. So, there are millions of new Medicaid enrollees. Medicaid rolls are increasing as there are millions of new Medicaid enrollees in some states.
Insurance Verification Eligibility
Insurance Eligibility Verification is the procedure of verifying a patient’s insurance with regards to Eligibility status, Coverage status, and Inactive or Active status. In simple words the process of checking patients insurance coverage and benefits before the date of service and verifying the authenticity of his or her claims to ensure payments.
Without this information, healthcare services may be derailed. The verification process must be done before the patient is being admitted into a hospital, sees a physician, or gets services from medical staff in order to avoid claim rejection.
Importance of Insurance Verification Eligibility
Insurance Eligibility Verification has become more important than ever with the arrival of the Affordable Care Act. One of the important components of revenue cycle management is Insurance Verification. Insurance verification and eligibility are important factors in ensuring prompt and accurate receipt of information regarding insurance coverage.
It also helps in determining the patient’s responsibility to pay for healthcare services. Many patients are unaware of how the insurance mechanism works, as it comes with many cost-sharing options They may not even know the difference between premium, co-pay, deductible, coinsurance, and out-of-the-pocket maximum –all of which together provide health coverage.
Most of the claims are denied or delayed because of gaps in patient information as indicated by the research. This may be caused due to failure to update the medical File of the patient at the front-desk/reception, or incorrect form-filling during their visit, insurance cover being expired, claim form missing, lack of pre-certification a mismatch between diagnosis and service provided, and so on. healthcare providers can submit clean claims as a result of performing eligibility verification.
It avoids re-submission of claim, reduces eligibility or demographic related denials and rejections, increases upfront collections, leading to an increase in patient satisfaction. Also, verifying authorization requirements before the service leads to an increase in collections and avoids denials.
The current environment is very complex with many factors working against healthcare providers to collect payments. Being transparent and proactive assists manage patient expectations and compliance with financial responsibility. Caught between practice administration and patient care, many physicians find it difficult to complete such important tasks on time.
We can assist physicians and healthcare practices with their insurance eligibility verification and pre-authorization process reducing coverage errors, minimizing rejections and denials, and improving bad debt write-off scores.
We not only work with payers but also with patients to provide authorizations for services or procedures to be provided and to verify eligibility. We are knowledgeable in every aspect of health insurance, healthcare terminologies, and medical/surgical techniques to submit error-free claims to increase cashflow.
About Medical Billers and Coders
We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.