Insurance verification—it’s not exactly the most exciting part of running your private practice, yet it’s absolutely crucial.
With insurance companies constantly updating policies and patients sometimes being unsure of their own coverage, the last thing you want is to deal with denied claims or unpaid bills.
Here’s the thing—thorough and proactive insurance verification can save you—and your patients—time, money, and headaches down the line.
Gathering New Patient Insurance Information
Starting on the right foot with new patients is essential. The moment a new patient calls to schedule their first appointment, make sure your front office staff collects all their insurance details upfront.
Here’s what you need to capture during that call:
- Policyholder’s name and contact details
- Insurance provider, policy number, and group number
- Patient’s relationship to policyholder
- Primary and secondary coverage, if applicable
Once you have this information, don’t wait until the last minute to verify it. Insurance verification can take time—so aim to start at least 72 hours before the patient’s first visit. This gives your team buffer time to sort out any discrepancies before the appointment.
Go Digital with Online Eligibility Checking Resources
Why spend hours on hold with an insurance provider when you can check eligibility online? Many insurance companies offer digital verification portals where you can quickly check whether a patient’s policy is valid and what their benefits include – (United Healthcare, for example). Tools like these can be game-changers for your practice:
- Real-time eligibility checks: Instantly confirm a patient’s coverage details.
- More accuracy: Minimize human error compared to manual processes.
- Speed: It’s way faster than calling payer representatives or digging through endless amounts of paperwork.
If you’re not already utilizing these resources, now’s the time to explore your options.
Monthly Re-Verification Matters
Here’s something not everyone does but absolutely should—perpetual re-verification. Insurance coverage changes frequently, and a patient’s policy could easily lapse, change, or be replaced without them realizing it. Regularly re-verifying your patients’ insurance:
- Helps avoid claim denials.
- Keeps your accounts receivable running smoothly.
- Protects your practice from financial disruptions.
Make it a practice-wide policy to re-verify insurance every month for all active patients. This small step can save you big headaches.
Introducing Automatic Insurance Verification Services
Still bogged down by manual verification processes? Enter automatic verification services. These tools integrate directly into your EMR and can single-handedly overhaul your insurance verification system.
Here’s why they’re worth considering:
- Time-Saving: Automatic verification reduces the need for calls and endless hold times.
- Seamless Integration: Many tools pull data directly into the patient’s chart in your EMR.
- Accuracy Boost: Eliminate human errors in manual data entry or interpretation.
For example, WebPT eBenefit Verification is a lifesaver for rehab practices. By automatically verifying patient benefits and recording that info in the EMR, it frees your front office staff to handle other tasks. Yes, these services come at a cost, but they pay for themselves through increased efficiency and fewer claim denials.
Your Go-To Insurance Verification Checklist
Whether you’re making a call or using an online portal, make sure your team gathers all the details needed to avoid claim issues.
Here’s a helpful checklist:
- Policy number, group number, and policyholder info.
- Claims address for the insurance company.
- Policy status and end date.
- Remaining benefits (e.g., therapy visit limits).
- Patient’s deductible, copay, and coinsurance amounts.
- Requirements for physician referrals, pre-authorizations, or documentation.
- Any coverage limitations or network restrictions.
Familiarize yourself with these questions so that every verification call delivers the insights your team needs. And if there are any unique, payer-specific quirks your practice has noticed, add them to your list.
Conclusion
When you prioritize insurance verification, you’re not just saving yourself time—you’re improving the patient experience. Patients appreciate knowing that their coverage is in order before their appointment starts. Better yet, you’re creating a more professional, efficient practice that minimizes financial risks.
Implement these tips and tools, and you’ll gain peace of mind knowing your revenue cycle management is on point, so you can focus on delivering exceptional care.
