Service Spotlight: Insurance Verification & Pre-Certification Services

Donna White

Donna White

By Donna White, Principal Consultant and Owner of Legacy Consulting Services and Legacy Billing Solutions in Montgomery, Alabama.

Many practices can get by with electronic batch billing through their EHR. This is a simple service that 2-3 days prior to the patient’s appointment, eligibility is checked to verify that the patient has active coverage. This system delivers a report of those who kick back without current coverage, so your registration team may reach out to the patient prior to their visit to make sure the most current insurance information is on file before the patient walks through the door.

However, for some practices, especially specialists, a simple “yay” or “nay” as to the patient’s eligibility may not be enough. For example, mental health benefits may need to be checked separately from regular medical benefits. Or surgical services need a detailed account of whether a pre-authorization is needed, and which specific CPT codes are covered and for how much.

On average, 40% of denials tie back to improper insurance verification and eligibility issues. We’ve talked about it before in previous blogs like Benefit Eligibility and Verification and the Front End of Revenue Cycle Management. Missing or incomplete insurance verifications lead to reductions in cash due to denials, delayed insurance payments, and unhappy patients who end up with statements they did not expect or that are not correct based on their insurance plans.

Legacy offers comprehensive benefit verification to include:

• Effective and term dates of coverage

• Co-pays

• Co-insurance

• Deductibles

• Type of plan and coverage details

• Payable benefits

• Patient policy status

• Type of plan and coverage details

• Plan exclusions

• Referrals and pre-authorizations

• Benefit maximums

• CPT code-level verification if needed (key for surgeries and procedures)

• Legacy can even obtain pre-authorization numbers and/or pre-certification numbers as required from the patient’s plan.

Contact us today to learn more about how Legacy can help your practice reduce denials and delayed payments with Insurance Verification & Pre-Certification Services.

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