Ensuring people have insurance before they get care is a big part of the healthcare business. People who work in healthcare can use this to figure out who pays for care without making mistakes that cost a lot of money. This is an important step, but many medical places still do it by hand, which can be dangerous. This blog aims to show healthcare workers the hidden risks of checking insurance benefits by hand and offer better ways to avoid these problems.

Understanding Manual Insurance Verification

Definition and Process

Most of the time, calling or writing the patient's insurance company is the best way to ensure they will pay for the care. This is called "manual insurance verification." When they return from calling the insurance company, people who work there type the information by hand. A part of this process is making sure that the insurance covers the services and checking the customer information.

People still use this method even though it wastes time and money and often leads to mistakes because they are used to it and don't know any better ones. Manual proof is very important in many parts of healthcare, like when a patient first comes in, before surgery, or to make sure they can pay for a planned treatment.

Common Practices

Manual checking usually happens at a few different times during patient care, such as:

• Intake of Patients: When people come in for their first visit, their insurance information is checked by hand. This means they usually must bring their insurance cards or paper records.
• Proof of Insurance Before Procedure: Before any surgery or medical procedure, the patient's insurance must be checked to ensure the care cost is covered.
• Continuous Verification: Insurance policies change over time, so continuous verification is important, especially for people who need to keep getting the same treatments or who have many different needs.

Healthcare companies still use a lot of human verification even though technology has improved. This is because insurance processes are hard to automate and cost a lot of money.

Hidden Risks of Manual Insurance Verification

While manual insurance verification may appear straightforward, several hidden risks can significantly impact healthcare providers and patients.

1. Human Errors

• Mistakes in Entering Data

One of the most significant risks of human verification is that mistakes could be made when entering data. When insurance information is entered by hand into systems, mistakes are easy to make. These can be anything from easy typos to entering the wrong information about a patient or their insurance policy. These mistakes can cause claims to be denied or funds to be delayed, messing up a practice's cash flow.

• Getting the wrong idea about information

There are a lot of complicated terms, conditions, and coverage details in insurance plans. When these details are looked over by hand, they could be misunderstood, which could cause the wrong bills. Charges can be made that the patient isn't responsible for or, even worse, for the provider not to get reimbursed if the patient's insurance coverage is misunderstood or a deductible is forgotten. Even though the business didn't mean to make these mistakes, they can cost time and money.

2. Time Consumption

• Lengthy Verification Process

Manually checking insurance is known to take a lot of time. Calling or faxing insurance companies, waiting for answers, and entering information by hand can take hours of staff time. That's time that could be spent directly caring for patients or doing other important administrative tasks. This slows down the verification process, makes it take longer to care for patients, and makes the business less efficient overall.

• Resource Intensive

Manual verification requires a lot of staff work, which wastes important human resources. There may be times when practices need more than one worker to do verification jobs that could be done by someone else. Smaller practices may put more pressure on the staff, which can generally lower the quality of care and patient satisfaction.

Financial Implications

• Increased Claim Denials

Human errors, such as entering incorrect details or failing to verify the right coverage, may increase claim denials. Incorrect verification or missing information on claims can lead to rejections, forcing the practice to undergo the rework process, which is both time-consuming and costly.

• Delayed Reimbursements
Cerification, claims often need resubmit, leading to delayed reimbursements. These delays can have a significant financial impact, especially for practices that rely on a steady cash flow from insurance payments. Delayed reimbursements impact revenue and force practices to spend additional time chasing up payments, which could have been easily avoided with an automated system.

Compliance and Legal Risks

• Non-Compliance Penalties

Inaccurate insurance verification can lead to non-compliance with healthcare regulations and insurance requirements. If a practice fails to verify insurance properly, it may inadvertently violate regulatory rules, leading to penalties or fines from insurance companies or governmental bodies. Compliance with ever-changing regulations is crucial for any practice, and inaccurate verification can expose providers to serious legal consequences.

• Legal Liabilities

A failure to properly verify insurance can expose healthcare providers to legal liabilities. For instance, if a provider inadvertently bills a patient for services that were covered by insurance due to poor verification, the patient may seek legal action for improper billing. In such cases, the provider may be forced to pay significant fines or even face lawsuits.

Patient Satisfaction

• Billing Surprises

When insurance verification is done incorrectly, patients may receive surprise medical bills. This happens when patients are told their services are covered, only to receive later unexpected bills for uncovered services or procedures. Such billing surprises can significantly diminish patient satisfaction and create distrust between the patient and the provider.

• Trust Issues

Repeated mistakes in insurance verification can erode trust between patients and healthcare providers. Patients expect clear, accurate, and timely information about their insurance coverage, and any errors in the verification process can result in dissatisfaction, confusion, and a negative perception of the healthcare provider.

Strategies to Avoid Risks Associated with Manual Verification

While manual insurance verification may seem like a necessary evil in many practices, there are effective strategies to mitigate the associated risks. The key is to implement systems and processes that can reduce errors, save time, and improve financial outcomes.

Implement Automated Insurance Verification Systems

• Enhanced Efficiency

Automated insurance verification systems can greatly reduce the time spent verifying insurance coverage. With automated tools, practices can instantly check eligibility and benefits, ensuring patients' coverage is confirmed immediately. This speeds up the process and eliminates long waiting times for patients and staff.

• Improved Accuracy

Automated systems reduce the likelihood of human errors in data entry and insurance interpretation. These tools are designed to handle complex policy details and accurately relay coverage information. As a result, providers can trust that the insurance information they receive is correct, leading to fewer claim denials and rework.

• Introducing mConsent's Solution

mConsent offers an advanced solution to insurance verification. With mConsent's automated patient engagement software, practices can streamline their insurance verification process and reduce errors significantly. Features such as real-time eligibility checks, automated reminders, and secure messaging ensure that insurance verification is both accurate and timely. This helps practices stay ahead of their revenue cycle and improves overall patient satisfaction.

Staff Training and Development

• Regular Training Programs

Practices should implement regular staff training programs to ensure that insurance verification is handled correctly. Equipping employees with up-to-date knowledge of insurance policies and verification procedures ensures that they can catch potential issues before they become problems.

• Continuous Education

Ongoing education is crucial to staying current with changes in insurance regulations and technologies. By encouraging continuous learning, practices can improve their staff's ability to handle verification tasks efficiently and accurately.

Utilize Real-Time Eligibility Verification Tools

• Instant Coverage Confirmation

Real-time eligibility verification tools offer immediate confirmation of a patient's insurance coverage. This allows staff to quickly confirm whether the patient's insurance is active and what services are covered without contacting the insurer manually.

• Reduction in Claim Denials

With instant coverage confirmation, providers can reduce claim denials and ensure all required information is captured during service. This leads to faster reimbursement cycles and minimizes the risk of billing errors.

Regular Audits and Process Improvements

• Routine Audits

Healthcare providers should conduct routine audits of their insurance verification processes to identify inefficiencies and areas for improvement. Auditing helps ensure that the verification process functions smoothly and that any issues are addressed promptly.

• Process Optimization

Based on audit findings, practices should implement process optimization strategies. This could include upgrading technology, refining staff workflows, or automating parts of the verification process to improve overall efficiency and reduce errors.

Conclusion

Recap of Risks

Manual insurance verification carries several hidden risks that can significantly affect a healthcare practice's efficiency and financial health. Human errors, such as data entry mistakes and misinterpreting insurance details, can lead to claim denials, delayed reimbursements, and compliance issues. The time-consuming nature of manual verification also diverts resources from patient care, while inaccuracies can result in patient dissatisfaction and trust issues. Moreover, non-compliance and legal liabilities are major concerns when verification is not properly handled.

Emphasis on Proactive Measures

Adopting automated insurance verification systems is crucial to mitigate these risks. Automation streamlines the verification process, reduces errors, and improves accuracy, ensuring faster and more reliable coverage confirmation. In addition to automation, investing in staff training, using real-time eligibility verification tools, and conducting regular audits are all proactive strategies that can further enhance operational efficiency and minimize the risks associated with manual processes.