Insurance Verification Technology Prevents Errors that Cause Costly Denials

From lean supply chain policies, to telehealth, and technology adoption — the pandemic is forcing the industry to take a hard look at the way it operates and scramble to adapt to a rapidly changing business environment.
09:03 AM
Doctor talking to mother and daughter at reception desk

By Juli Forde, Director of Strategic Partnerships, ZOLL® Data Systems

2020 is destined to go down in the healthcare history books as the year that drove change in many areas. From lean supply chain policies, to telehealth, and technology adoption — the pandemic is forcing the industry to take a hard look at the way it operates and scramble to adapt to a rapidly changing business environment.

In the long run, that may not be a bad thing. Necessity is the mother of invention. The need to cut costs and find more revenue is on every RCM professional’s mind at a time when volume is down, and the self-pay and high-deductible health plan (HDHP) populations are up. The urgency of the situation is driving innovation in accounts receivable (AR) management, starting with the pre-billing process.

Manual Insurance Verification Limitations

Many facilities rely on a team of insurance and compliance staff to conduct manual insurance discovery and verification on every claim. In an era in which so many industries are automating more and more of their data-driven activities, it’s time for healthcare organizations to look for ways to improve this labor-intensive and error-prone process.

Without insurance verification technology, it’s nearly impossible for billers to obtain complete, accurate results. The pandemic-induced fluid employment situations and housing instability for many individuals are making it more challenging than ever to verify insurance coverage information. In addition, benefits for those who do have coverage have been rapidly changing, including temporary benefits with sunset clauses that may be extended one or more times.

Using Technology to Minimize Errors and Maximize Effectiveness

The good news is that today’s AR optimization tools can rapidly provide billers with service type, co-pay, deductible, and benefits information via a single point of access. Technology turbo-charges search capabilities by querying and cross-checking multiple data sources to present benefits and eligibility in real time. Insurance discovery tools are especially beneficial in the COVID-19 environment with the growing number of telehealth claims and increasing incidence of outdated or incomplete demographic and insurance information. When you’re ready to bring insurance verification technology into your organization, look for:

  • Configurability. For maximum effectiveness, you want to have the flexibility to configure real-time options for Medicare replacement payer, managed care plans, and state Medicaid when the patient is Qualified Medicare Beneficiary (QMB) identified.
  • Redundancy. You want layers of redundancy in place so that your workflow is seamless, even when a clearinghouse goes offline. Searching multiple data sources guards against disruptions, as well as ensuring accuracy.
  • Dynamic Payer Routing. Billers can erroneously specify the wrong payer to search, resulting in no coverage located. Look for dynamic search capabilities that use subscriber ID information to identify the correct payer automatically.
  • Receivables Expertise. Technology alone has limitations. A viable insurance verification tool should be built on deep, foundational understanding of healthcare receivables and reflect the industry expertise and experience of the company behind it. Look for a true partner who knows your business and will be there to support you beyond the sale.

The year 2020 has been challenging for the healthcare industry, but it has also opened the doors to new opportunities. There’s no better time than now to take advantage of insurance verification technology to replace manual processes that leave billers vulnerable to denials caused by preventable errors. With the need for running eligibility transactions on multiple websites eliminated, billers can spend far less time on verification and create a much more efficient, effective claims submission process. The result is an increased clean claim rate and a shorter time-to-cash which is precisely what every healthcare organization is looking for right now.

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Digital Transformation

Top row - left to right: Dr Don Rucker, National Coordinator for Health Information Technology (ONC), HHS Office of the Secretary, US, Tim Kelsey, SVP - Analytics, HIMSS, Australia and Dr Ahmed Balkhair, Saudi Arabia’s Digital Transformation Advisor, Ministry of Health. 

Bottom row: Dr Anne Snowdon, Director of Clinical Research - Analytics, HIMSS, Canada.

Malaffi, COVID-19

Credit: Malaffi CEO, Atif Al Braiki

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