8 Important Reasons to Verify Insurance in Your Ophthalmology Practice

By Michael Carroll on July 12, 2018

Verifying insurance is a critical part of your everyday practice operations. It’s easy to check patient cards as they come in, but verifying their coverage with their company is a critical step that you must take before offering treatment–even if you’re working with a long-term patient. Not only is it important to ensure that the patient still has the insurance coverage they’re claiming, there are several reasons why a lack of timely insurance verification can create problems for your practice.

Reason #1: Registration Errors

When you enter your patient into the system, you want to be sure that you’re giving clear, accurate information. Registration errors, including duplicate accounts for the same patient due to misspellings, nicknames, and other key problems can be costly to both you and your patients! Registration errors can lead to claims being denied, problems identifying the right patient within your practice, and poor communication with patients–which can cause serious problems after major procedures or if patients are in need of follow-up care. By verifying insurance, you’ll increase the odds that you have the right patient and that you’ve collected the key details necessary to ensure that you’re not going to end up with those errors.

Reason #2: Trouble Collecting Copays

When your patient checks in with the office, they need to know how much they’re responsible for paying. Collecting those copays on the spot is a critical first step in keeping your office running smoothly. Without insurance verification, however, your front desk staff may fail to collect the right copay, either under- or overcharging your patients. Worse, they may neglect to collect a copay at all, leaving you scrambling to collect those fees after service has been provided. When you verify insurance before collecting copays, however, you’ll know exactly how much each patient owes, and you’ll be able to collect that amount before they leave the office. Collecting the right copays also helps decrease your billing paperwork and leaves your office staff with more time to focus on other activities.

Reason #3: Delays in Charge Entry

Charge entry is a critical step in your medical billing process–and delays in it can increase the time it takes you to get paid for the services you’ve provided. Unfortunately, your charge entry process can be significantly delayed by failure to verify insurance while your patient is in the office. Delayed insurance verification makes it difficult to determine patient responsibility with regard to payment for services. Depending on the insurance held by the patient, you may need to enter discounts or other information. Slowed insurance verification makes it impossible to calculate those numbers, which in turn makes it difficult for you to balance your books.

Reason #4: Posting Errors

Posting errors, or entering information in the wrong columns of your books, are more common when you fail to properly verify insurance information. You may, for example, think that the insurance company is responsible for paying a specific amount after treatment. Upon verification, you unfortunately discover that the amount is different than what you thought, leaving your records out of place and making it difficult for you to assess where payments need to come from.

Reason #5: Delays in Claim Submissions

When you work with insurance companies, you know that you need to submit claims for treatment as soon as possible. Delays in claim submissions may in turn delay payment of the amount the insurance company is responsible for. Not only that, extensive delays in claim submissions may lead to claim denials or other difficulties that can impact both you and the patients. Verifying insurance before treatment, on the other hand, will allow you to keep up with claim submissions and ensure that you’re sending them to the right place.

Reason #6: Claim Submission Errors

Insurance companies are notorious for denying claims over the smallest details–and you want to be sure that your ophthalmology patients don’t have to deal with tedious paperwork, nor do you want to have to resubmit your claims. By verifying insurance up front, you’ll ensure that you’re using the right codes to put the claims through properly. This means proper payment for you and proper coverage for your patients–both of which can significantly impact peace of mind.

Reason #7: Claim Denials

Claim denials do happen. A patient has maxed out their coverage for the year; the procedure they’re receiving doesn’t seem to be indicated by the symptoms; the insurance company has, for whatever reason, decided that a specific procedure isn’t covered. Verifying insurance before performing a procedure prevents this from being a nasty surprise for both you and the patient once the procedure is complete, especially when it comes to expensive procedures that a patient might not be able to afford on their own, without that help from the insurance company.

Reason #8: Increased Write-Offs

When you fail to collect insurance verification at the beginning of an interaction with a patient, problems with claim submissions and claim denials can mount fast. Since the treatment has already been provided, there’s no taking it back–and often, that ultimately leads to the decision to write off the amount of the treatment, especially if patients are unwilling or unable to pay out of pocket for the cost of the treatment they’ve received. Insurance verification early in the process, on the other hand, will let both you and the patient know what their insurance company will cover. This, in turn, allows you to make critical decisions about patient care based on the best possible information.

Verifying insurance should be part of the initial stages of patient interaction when they walk into your office. Simple insurance verification can prevent a number of key problems in the bill posting and collection process, allowing your practice to continue moving more smoothly. Need more help collecting and verifying insurance information for patients? Contact us today to learn more about how we can streamline patient interactions and ensure that you’re able to make patient care choices based on the insurance coverage they actually have, not coverage that they once had or that they think they might be able to use.