We help Dental Offices with patient’s benefits verification prior patient’s appointment, as many times, it has been observed that patients are unaware of cost-sharing options with their insurances. They may not even know the difference between premium, copay, deductible, coinsurance, and out-of-the-pocket maximum – all of which work together to make patient’s plan. Due to this unawareness and confusion upon billing them the accurate cost-sharing amount, they feel cheated. Having negotiated lower payment rates, they feel cheated when availing an out-of-network service takes up their bill. They are puzzled that they are denied coverage, letter realizing that they may not have met the deductibles. These along with the gaps in patient information are the potential reasons for claim denials and delays. This may be linked to incorrect form filling during their visit, or failure to provide updated information to front desk/reception, expiry of insurance cover, lack of pre-certification and so on. Insurance Eligibility Verification is the procedure of verifying the Active or Inactive policy status, checking complete plan benefits which includes Plan Type, Provider Participation, Frequency, Annual deductible, Copays, Co-Insurance & Out of Pocket benefits. This information is directly linked to claim denials or payment delays, especially the account receivables (A/R). This happens when the eligibility verification is not performed correctly.
We also create plans in the software as and when needed once the verification is completed for the patient. The plan details include all the components of patient plan such as Plan Type, Frequency, Annual deductible, Copays, Co-Insurance. This information gets linked with patient account which helps office to determine the remaining benefits on the patient plan. As dental plans have yearly (Calendar/Fiscal) coverage it makes easy for office to calculate the remaining benefits on patient’s plan.
Credentialing Process refers to the process of verifying the proven skills, training, and education of healthcare providers. Verification of the providers’ credentials is done by contacting the “Primary Source”, which has provided the license, training, and education. The credentialing process is used by healthcare facilities as part of their hiring process and by insurance companies to allow the provider to participate in their network. Credentialing is also the validation of a provider in a private health plan and the approval to join the network. It is very important to remember that in today’s world of health insurance and revenue cycles, improper credentialing can lead to delayed or denied reimbursement for services provided.
There are certain services that require or suggested pre-certification, pre-notification, or pre-authorization from the insurance company. We make sure whether a service requires pre-authorization during the Insurance verification process. What is exactly pre-authorization, why is it required, and which are the services that need that? Need of obtaining the approval or authorization from an insurance carrier to pay for a proposed treatment or service. This approval is based on medical necessity, medical appropriateness, and benefit limits.
Account Receivable Follow-Up
We have a team of specialist for accounts receivables clearance. Insurance accounts receivables is a common problem within all type of practices. This causes a reduction in cash flow and loss of revenue. We pursue every old claim by assigning our dedicated team of Aging A/R specialists.
Many Billing Companies, consider and treat the work of Payment Posting as a Data Entry process and do not assign this work to Industry Experts rather assign it to some inexperienced staff to get rid of the work at a low cost. At Revesolv, we do not take this approach for the payment posting work. We consider this work an important part of the Revenue Cycle Management Process. Every EOB/ERA has many things and criteria to observe like, (Billed amount, allowed amount, Patient Responsibility, Provider Discount, Check number, Check issue date, Check sent Address, information of cashed or not and information if the claim was forwarded to the secondary payer or not?
Having this much information on the EOB/ERA, how can anyone consider this work, as easy as data entry or typing work? Revesolv, got the industry expert who knows how to read any kind of payer EOB/ERAs. They take much caution while putting the details in your Practice Management software which can improve the accuracy of the data in your Practice Management Software for your monthly, yearly comparison. Accurate Payment posting can guarantee the collection per your agreed fee schedule from the payers, it can avoid direct billing to patient missing billing to secondary. It will help the office to get a clear picture of patient & insurance outstanding.
Posting a denial is more important than posting a payment. Because, this is the place where the revenue is stuck. We at Revesolv make sure that all the denials are posted correctly and appropriate action is taken on each denials which can help to resolve the claim and get paid .
Upon getting the accurate picture of insurance and patient outstanding balance in Practice Management software, Office Front desk, and effectively collect the amount from the patient upon having the patient at the office before the visit. Yes, every practice has few indiscipline patients who don’t pay their outstanding on time. Even a small ratio of such patients impacts the Practice revenue flow in the longer run. Here in such scenarios practice loss time and monies so Revesolv is at your rescue by offering reminder calls to your patients. We follow up with your patients and request them to remit the payment at the office at earliest. Such calls happen after the non-response of patients receiving 3+ statements from us. Moving such accounts to a collection agency should be the last option for any practice.