GeBBS Healthcare RCM Blog

Pre-authorization as a Service Requires Both Technology and Human Components

Posted on Tue, Aug 21, 2018 @ 09:00 AM

Most claim denials are due to the lack of verifying benefit information prior to services being provided. Insurance verification process is crucial for all hospital encounters, whether inpatient, outpatient or ambulatory care. It will ensure that the hospital or physician receives payment for services rendered and will help determine the patient’s share of the charges referred to as the patient’s responsibility.

Eligibility verification is the process of checking a patient’s active coverage with the insurance company and verifying the authenticity of his or her claims. In order to avoid claim rejection, the verification process must be done before the patient is admitted into a hospital, sees a physician or gets services by a medical professional.

Coverage and eligibility benefits should be verified for all new patients and hospital admissions. Coverage and benefits will also be verified for any patient who indicates a change to their coverage and for all high dollar procedures. Pre-authorization is required for many non-emergency medical procedures and services.

GeBBS end-to-end, comprehensive revenue cycle management (RCM) solutions provide this pre-authorization as a service using both technology and human elements. With 12+ years of RCM experience, our billing experts are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. We follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of our proven experience and expertise.

Our solution includes:

  • Scheduling, Eligibility Verification, and Pre-Authorization
  • Customer/Patient Contact by knowledgeable healthcare professionals

The solution renders many benefits including:

  • Reduce overhead costs and streamline staff workflow
  • Improve overall yield by reducing denials
  • Improve patient satisfaction scores (no more turning patients away or rescheduling)
  • Improve referring doctor relationships
  • Focus on patients not paperwork

 

Among the major trends affecting healthcare payments are the new high-deductible insurance plans. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressure. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through pre-authorizations of services covered, payment plans, and more. GeBBS patient access management solutions make it easier for patients to stay on top of their new responsibilities, lowers your costs and increases revenue.