A Brief Outlook on the Medical Insurance Verification Software

Medical insurance verification software is developed to automate the process of verifying patients’ insurance coverages. This software is connected to the insurance company’s database to retrieve real-time data on a patient’s insurance status. The software is also linked with the provider’s system, so they can also verify patient’s coverage and claims.

A medical insurance verification software checks for coverage benefits, copayments, deductibles, and other relevant information needed for the healthcare provider to proceed with the patient’s care.

Key Statistics:

1. As per the 2023 survey published by the CDC, the number of people younger than age 65 uninsured was 24.7 million.
2. CDC reveals that 10.9 percent of the adults between the age group 18–64 were uninsured, as per the 2023 survey.
3. CDC also reveals that 3.9 percent of children younger than age 18 were uninsured, as per the 2023 survey.
4. According to the United States Census Bureau, more people were insured in 2022 than 2021. In 2022, 92.1 percent of people, or 304.0 million, had health insurance at some point during the year, representing an increase in the insured rate and number of insured from 2021.
5. The Census Bureau further reveals that in 2022, private health insurance coverage continued to be more prevalent than public coverage, at 65.6 percent and 36.1 percent, respectively.

Before jumping to medical insurance verification software, it is essential to understand that traditionally the verification was a manual process. The admin staff in the healthcare facilities spent hours on calls with the insurance companies, manually checking coverage details, patient eligibility, and benefits.

This method was not only inefficient, but also left considerable room for human error. This eventually led to denied claims, increase in operational costs, and delayed payments. So, with the introduction of medical insurance verification solution, the whole process is automated to save time and resources.

Benefits of Using Medical Insurance Verification Software

The adoption of medical insurance verification software brings numerous benefits to the healthcare providers, insurance companies, and patients.

1. Reduced Errors: Automation feature of the medical insurance verification software minimizes human errors which are usually caused due to manual data entry. Reduced errors leads to fewer claim denials and delayed payments.
2. Improved Efficiency: In a manual insurance verification process, the admin staff enters the insurance documentation into the system and then calls the payer to confirm eligibility. This takes up precious time. Automating the insurance verification process decreases the effort and time required from the admin staff, thus allowing them to focus on other essential work.
3. Patient Satisfaction: Patients don’t like to hear that their claim was denied because the staff failed to verify eligibility. They want this information prior to consultation with the provider. Frustrated patients may not come back second time. So, to build patient satisfaction, integrate a medical insurance verification software. This software confirms eligibility quickly and it also informs about the coverage, limits on benefits, and out-of-pocket experiences.
4. Revenue Cycle Management: Clean claims and faster reimbursement improves the overall revenue cycle for the healthcare providers. Also, clarity of insurance filling limits, claim scrubbing, and a denial management review process can ameliorate revenue cycle management. Plus, updated patient information, verified eligibility, and current payer changes can also help in revenue cycle management.
5. Submission of Clean Claims: Insurance eligibility verification is one of the biggest steps towards submitting a clean claim. So, claims by patients not in network are immediately rejected by the insurers. Make sure that the patient is eligible, so providers can get timely reimbursements.

Features of Medical Insurance Verification Software

Several medical insurance verification software are available in the market. Each of them with its own set of features and functions. However, certain features are common in all of them and they are as follows:

1. Real-Time Insurance Verification: Insurance verification software checks a patient’s insurance status at real-time. With instant medical insurance check, the admin staff can inform the patients whether they are eligible for claim or not.
2. Batch Workflows: The medical insurance software conducts batch workflows, which means processing queries of multiple patients simultaneously. This saves plenty of time and enhances patient satisfaction rate too.
3. Eligibility Check: The software can automatically check the patient’s eligibility for specific treatments and services, thus reducing the likelihood of claim denials and assuring that the patient is covered for the treatment procedures he/she needs.
4. EHR/EMR Integration: The software must integrate with the existing EHR/EMR system and practice management software. This integration will facilitate data transfer of eligible patients.
5. Pre-Authorization: Several insurance verification software include features for managing pre-authorizations, thus streamlining the approval process for treatments that need prior consent from the medical insurance company.
6. Reporting and Analytics: Reporting and analytical tools helps admin staff to gain insights about the verification process, allowing them to spot bottlenecks and areas for improvement.

Potential Challenges You Must Know

While medical insurance verification software offers several advantages, there are potential challenges that you must not forget.

1. Firstly, there’s a significant initial cost involved while implementing the software. The providers must weigh long-term benefits against the upfront investments.
2. The next thing to keep in mind is the interoperability issue while integrating with the existing EHR/EMR system and the practice management software. To ensure seamless integration and data exchange implement standards such as FHIR and HIPAA.
3. Nothing compromises workflow, privacy, and errors more than the lack of staff training. So, the entire admin staff and providers must be trained to use the new software effectively.
4. The next potential challenge could be data inaccuracy. The effectiveness of the insurance verification software depends on the accuracy of the data provided by the insurance companies. Outdated or inaccurate data can lead to verification and eligibility issues.

Conclusion

Medical insurance verification software has revolutionized the way insurance claims work. By automating the traditional manual process, the software has the potential to reduce errors, improve patient satisfaction, reduce denial rate, and improve revenue cycle. So, for healthcare providers looking to stay competitive, invest in a robust medical insurance verification software and provide the best possible care. To get a top-notch medical insurance verification software, connect with the experts in the field.

Arkenea, a healthcare software development company specializes in delivering world-class software solutions that addresses the evolving problems faced by the providers, insurance companies, and hospitals. So, hop on a consultation call with us to know more.