Insurance verification is one of those things no one wants to do in a medical office, but it must get done. Every patient needs to have their insurance confirmed prior to entering the door, and when that doesn’t happen, everything falls apart. The front desk gets backed up, patients become angry when receiving bills, they didn’t expect post-appointment, and the entire revenue cycle becomes disrupted. Yet offices with current staff levels are already overworked, and hiring someone just to make the insurance calls, full-time, doesn’t make practical financial sense for smaller practices.
The Daily Insurance Verification Grind
This is how it works in most medical offices. The front desk person makes insurance calls multiple times a day, verifying coverage, copays, deductibles, and what’s covered under what plan. And it isn’t a two-minute phone call. The hold times average 20 minutes plus, if the person on the other end has everything they need when they pick up. In the meantime, the phone is ringing off the hook with new patients needing to schedule appointments, patients have checked in for their visits, and someone needs to answer a billing question from someone coming from yesterday’s appointment.
This creates an ongoing battle between getting the insurance verification done and managing other responsibilities. When staff rushes through verifications to get back to other tasks, errors occur. Claims are submitted with incorrect billing information, patients believe that their treatments are covered and they’re really not, and the practice must follow up trying to collect what should have been verifiable at the onset.
Why Hiring Staff Doesn’t Always Help
Practice managers have certainly considered bringing someone onboard solely for insurance verifications. The math adds up when looking to fill one problem with one person. But soon it gets complicated. One full-time employee dedicated to insurance verification means salary, benefits, payroll taxes, office space, computer setup and downtime for training. For a practice that needs insurance verification but doesn’t have enough volume to keep someone busy for 40 hours a week, it doesn’t add up.
There’s no coverage either. Now, once that person goes on vacation or calls out sick or leaves for a better paying opportunity, everyone is back at square one trying to juggle staff responsibility with their other responsibilities. Some practices have attempted to cross-train existing staff to take on this additional responsibility; however, that means they all get trained, but none become proficient at it, and hold times steal everyone’s day.
The Other Option
But more practices are finding success with a virtual medical billing assistant and solving the insurance verification concern without the overhead of an additional in-person employee.
These professionals work remote and handle insurance verification as it’s needed during the day; they gradually work through scheduled patients and document them in the practice management system in real time throughout the day. Trained on insurance processes and the systems that different carriers have, they’re well-versed and equipped to handle whatever holds without taking time away from medical staff who need to be taking care of patients.
Generally, this works if remote billing staff have appropriate access to the practice’s scheduling and billing software. They access the upcoming patient lists, pull insurance information from the appropriate screens, reach out to carriers for verification of coverage amounts due and then document accordingly any copay amounts, deductible dues and if prior authorization is needed.
They’re doing the same work an in-house employee would do from just another location.
How This Is Accomplished
The transition comes with a bit of a test run first; there are optimal times for insurance verification within medical practices—first thing in the morning for appointments scheduled that day; later in the afternoon for appointments scheduled for the next day, but these can create staff bottlenecks attempting to prioritize calling an insurance company over greeting potential paying patients.
However, once this milestone is met, the pressure is taken off of front-desk staff. They no longer need to sit on hold when they should be calling patients back.
With communication systems available today that did not exist five years ago enable this functionality regardless of where people are physically located. Secure messaging platforms allow remote billing teams to tag urgent issues, ask questions about specific patients, and coordinate efforts with front desk staff in real-time when issues arise, which require immediate attention (like someone whose insurance lapsed two months ago and is now attempting to see their doctor).
In addition, many practices appreciate that remote billing assistance is consistent. The same group typically gets attuned to the practice’s most common carriers, what commonly needs prior authorization or not, as well as how different plans require strange documentation, creating a reliable process of verification that’s more reliable than different employees who’ve never taken the time to learn any rhythm.
The Impact This Has on Practice Operations
When consistent verification occurs, and thorough, everything else falls into place. Front desk staffing isn’t constantly bombarded trying to juggle patients and phones ringing off the hook from carriers; instead they can focus on welcoming patients into their visits, keeping them on time (or adjusting schedules) for administrative questions, or giving clearer feedback about financial responsibility.
Many verifiable issues avoid reimbursement complications later on down the line. A clean revenue cycle occurs because claims are submitted with realistic information up front.
These practices often find a noticeable change in employee morale as well; no one’s fighting over whose turn it is today to make the verification calls, but everyone can actually complete their core responsibility without being pulled away every day at least once for some sort of verification concern.
It’s not glamorous work but it’s necessary work that will keep a medical practice financially solvent. When it’s done correctly without adding unnecessary overhead it only helps practices maintain their level of care without compromising expensive operational costs.
Also Read: Health Insurance Plans With No Waiting Period: Myth or Reality?
