Verifictaion of Insurance Benefits

Significance of verification of insurance benefits in the medical billing process

Health insurance verification

Optimizing your revenue cycle management begins with a full-bodied health insurance verification process. RND Softech's dedicated healthcare revenue cycle management team ensures a seamless experience by conducting a thorough insurance eligibility check and verification of benefits for each patient. We prioritize accuracy in gathering protected health information (PHI) and insurance information, validating coverage and streamlining insurance verification. This detailed approach enhances claims processing efficiency and minimizes errors, leading to faster reimbursements. Trust us to handle the complexities of coverage validation, providing a comprehensive and reliable health insurance verification solution that contributes to a healthier revenue cycle for your healthcare practice.

Managing insurance claim flow

RND Softech's dedicated team specializes in continuous claims processing, ensuring a streamlined experience from submission to settlement. Trust us to navigate the complexities of insurance coverage, providing comprehensive support for policy claims. We prioritize accuracy in claim reimbursement, utilizing advanced tools to expedite the process and minimize delays. Choose RND Softech for a transformative experience in managing insurance claims, offering a comprehensive solution that enhances efficiency and accuracy in your revenue cycle management (RCM) strategy.

Context of verification in overall Revenue Cycle Management (RCM)

RND Softech, expertise in healthcare revenue cycle management covers various stages, starting from patient registration and extending to the final payment stage. In this elaborate web of activities, the verification of insurance benefits stands out as the foundation that supports the entire healthcare revenue cycle. The initial step involves obtaining accurate and up-to-date information about a patient's Protected Health Information (PHI) and insurance coverage to facilitate smooth billing and reimbursement processes.

Improving revenue cycle through insurance validation at RND Softech

Patient registration:

We verify and collect accurate patient demographic information, including name, address, date of birth, and insurance details. Confirm the patient's health information, insurance coverage and policy information.
Insurance eligibility verification:

We verify the patient's insurance coverage and eligibility before providing services. Confirm the patient's plan details, including deductible, co-pay and co-insurance information. Check for any pre-existing conditions or limitations in coverage.
Authorization confirmation:

We ensure pre-authorization or pre-certification requirements are met for specific medical procedures or services. Confirm the validity and approval of any required authorizations.
Claim submission:

We generate and submit accurate insurance claims electronically or through the appropriate channels. Include all necessary supporting documentation and codes required for reimbursement.
Timely filing:

Adhere to insurance company deadlines for claim submission to avoid claim denials due to late filing. We monitor and track claim submission timelines for each insurance payer.
Claim scrubbing:

We are implementing a robust denial management process to address and appeal denied claims promptly. Analyze denial patterns to identify root causes and implement corrective actions.
Denial management:

We are implementing a robust denial management process to address and appeal denied claims promptly. Analyze denial patterns to identify root causes and implement corrective actions.
Coordination of Benefits (COB):

Verify and coordinate benefits when a patient has multiple insurance plans. We determine the primary and secondary payers and ensure proper billing to each.
Electronic Data Interchange (EDI):

Utilize EDI capabilities for electronic communication between healthcare providers and insurance companies. We ensure compliance with EDI standards to streamline claim processing.
Reconciliation and auditing:

We regularly reconcile accounts and audit claims to identify discrepancies or potential issues. Conduct internal and external audits to ensure compliance with regulatory requirements.
Staff training and education:

We provide ongoing training to staff members involved in the revenue cycle to stay updated on insurance industry changes, coding updates and best practices.
Contract Compliance:

Ensure compliance with contractual agreements with insurance providers. We monitor fee schedules, reimbursement rates and any specific requirements outlined in provider contracts.
Technology integration:

Utilize integrated healthcare information systems to facilitate seamless communication and data exchange between different revenue cycle stages.
Patient communication:

We communicate with patients about their insurance coverage, co-pays and financial responsibilities. Educate patients on the importance of providing accurate insurance information during the registration process.

Advantage of insurance verification benefits

Preventing claim denials

Only complete or accurate insurance information can lead to claim denials. Verifying insurance benefits before providing services reduces the risk of rejections, ensuring a smoother reimbursement process.

Accurate financial planning

Understanding a patient's insurance benefits enables healthcare providers to create accurate cost estimates, helping patients plan for their financial responsibilities and reducing surprise billing issues.

Claim processing

Once insurance benefits are verified, the subsequent steps in the revenue cycle, such as claim processing, are significantly streamlined. Accurate information at the outset reduces the likelihood of errors, minimizing the chances of claims being rejected or delayed.

Accurate verification of insurance benefits plays a crucial role in managing, Revenue Cycle Management (RCM) and as healthcare providers navigate the complexities of healthcare finance, understanding and implementing effective strategies for insurance benefits verification become imperative. By doing so, providers can optimize their revenue cycle management and enhance patient satisfaction and financial transparency, ensuring a sustainable future in an ever-evolving healthcare background.

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Frequently asked questions

The business world is being flattened by economics, technology, demographics and regulations. To win in this flattening world, companies must transform their way of working to seek and convert new opportunities wherever those opportunities may be. This means acquiring the ability to disaggregate your operations, people and resources across time zones, geographies, cultures and sourcing and delivering.

Why should I outsource to RND Softech?

By outsourcing to RND Softech, you will experience an immediate reduction of up to 60% in your manpower costs. We provide staff to take care of your front end and backend operations. This will enable you to focus on growing your business without having to worry about increasing operational costs, employee attrition, etc.

What are the services you offer?

We offer entire Revenue Cycle Management - a few of them being, data entry, insurance verification, authorization, Doctor's office followup, intake, order processing, billing, denial management, payment posting, inbound and outbound patient calling, 24 x 7 customer support, scheduling processes etc.

Do you have experience of working in the healthcare industry?

Yes, we have more than 22 years of experience working in the US healthcare industry. We have been providing medical transcription services to hospitals across the United States since 1999 and DME/Home care back office services since 2012.

What is your onboarding period for a new employee/customer?

Anywhere between 1 to 14 days.

What would be the FTE's working hours?

The FTE would work the US working hours, in the time zone of your choice.

Is the contract obligatory? Is there a minimum or maximum contract period?

Yes, but it is a no-obligations contract and is non-binding and there is no minimum contract period. The contract simply states that the two companies are entering into a partnership for the providing and receiving services. You can terminate the contract if you are not satisfied with the services. A notice period of 1 month is appreciated but not mandatory.

Are you HIPAA compliant?

Yes, we are certified for HIPAA and Information Security Management Systems.

Is there any contract to be signed before getting started?

No, the contract is not obligatory and there is no minimum contract period. The contract simply states that the two companies are entering into a partnership for the providing and receiving services. You can terminate the contract if you are not satisfied with the services. A notice period of 1 month is appreciated but not mandatory.

Do you follow FTE based billing or percentage of revenue generated billing?

We follow an FTE-based billing. One FTE (full time employee) works 8 hours a day, 5 days a week - a total of 40 hours a week.

How will I be billed?

You will be sent an invoice each month mentioning the number of FTEs agreed upon and the services provided.

How can I make payments?

You can make payments through Paypal using your credit card or make a wire transfer.

Are the FTEs your own employees or do you subcontract to other smaller companies?

All our FTEs are employees of RND Softech and are dedicated to each client, the agent will not be shared with other clients

Where are you located?

We are located in Southern part of India.

Do you follow US holidays or local?

Yes, We follow US holidays.

Are You Certified?

Yes we are one ISO 9001, ISO 27001, HIPPA and SOC2 Certificates.