10 tips medical billing companies can give to speed up insurance payments
Learn how to help your medical practice clients slash payment delays and denials with these 10 proven insurance verification strategies.
At a Glance
- According to Tebra research, over half of billing companies report that practices delay their own insurance payments by providing inaccurate information, highlighting a critical need for better eligibility verification processes.
- Consistent verification of patient eligibility, thorough documentation, and careful attention to network/payer distinctions are essential steps for expediting insurance payments.
- Special attention should be paid during transitions (staff changes, new providers) and for complex cases (MCO vs. straight Medicare/Medicaid, EPO plans) to prevent payment delays and denials.
According to Tebra's 2024 Medical Billing Benchmark Report, 55% of medical billing companies say that practices slow down insurance payments because they provide inaccurate information. This underscores that practice staff must thoroughly understand eligibility verification to facilitate efficient claims processing and timely payments.
As a billing expert, you’re coming in to assist healthcare practices in optimizing their coding procedures. You can support established and growing practices with much-needed expertise and attention to detail — for improved insurance accuracy and verification.
Here’s some advice medical billing companies can give their clients to increase verification accuracy and speed up the claims process.
10 tips to help your clients expedite insurance payments
These steps can help your clients improve claims processing and the speed at which they receive payments.
1. Verify eligibility early and often
Ideally, practices should verify patient eligibility before the first visit and at every subsequent visit. Don’t assume that because a patient was eligible last week, they still are.
2. Document the details
Keep a record of each verification, ideally using integrated eligibility in your software or payer websites so you also have documentation from the payer. If you have to verify eligibility over the phone, document the date, time, name of representative, and details of benefits.
Learn about Tebra’s integrated eligibility checks for practices.
3. Confirm payer vs. network
Always double-check that you’ve differentiated between the network and the payer. When in doubt, check the back of the insurance card where it says “send Medical claims to” or “send Behavioral Health claims to,” depending on your specialty.
“Always double-check that you’ve differentiated between the network and the payer.”
4. Remind patients to verify the coordination of benefits
Notify patients to call their payers to verify the coordination of benefits when requested by their insurance. Payers are requiring these updates more frequently than once a year in many cases, and only the member can fix it with the payer.
5. Check patient plan participation
Make sure the patient’s plan is included in your network contract. For example, an Exclusive Provider Organization (EPO) plan is a limited network in which providers cannot elect to participate — they must be invited.
6. Obtain authorizations
Get authorizations when required. Remember that medical necessity appeals for missing authorizations are not usually successful — especially when the service is not an emergency.
7. Confirm Medicaid/Medicare type
For Medicaid and Medicare patients, always verify if the patient has an Managed Care Organization (MCO) instead of straight Medicaid or Medicare. Verify it every month, as authorization/referral requirements are different depending on the payer.
“For Medicaid and Medicare patients, always verify if the patient has an Managed Care Organization (MCO) instead of straight Medicaid or Medicare.”
8. Submit PCP changes ASAP
Note that MCOs require members to select a primary care physician (PCP) and that one is usually auto-assigned. If it is not you, the change must be submitted at the first visit. You might even discover you’re not in network with the MCO.
9. Audit during staff transitions
Take extra care when there are employee changes, especially front-office turnover.
- Audit any new patient to verify the accurate collection of patient information during these times.
- Respectfully communicate errors when they arise to improve accuracy and training.
10. Clarify coding with new providers
Review coding and documentation standards whenever a new provider joins the practice to ensure accurate billing and reduce the risk of claim denials.
Smoother operations, faster payments
Practices that eliminate missing information and gaps in the verification process can significantly streamline the billing process. Committing to accuracy and consistency when verifying eligibility removes frustration and fosters a more effective revenue cycle, positively impacting both practices and billing companies.
Tebra’s medical billing software supports accurate insurance verification, efficient claims processing, and management of patient payment responsibilities. Explore our products or schedule a demo to learn how our solution benefits billing companies and their clients.
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Learn the secrets of high-performance medical billing companies in our 2024 Medical Billing Benchmark Report.
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