Verification of Benefits Role in Clean Claims & the Revenue Cycle

It is a waste of time and money to circle back on a claim that should have been clean and accurate from the start. At the beginning of the revenue cycle, hospitals must verify whether a patient has active insurance on the service date to ensure accurate medical claims submission and improved claims management.

Verification of Benefits (VoB) ensures providers have the right demographic and insurance information from the patient, and a payer will cover the visit. This enhances the ability to collect payments efficiently and reduces claim denials due to incorrect insurance information. Implementing an automated, cascading process, from benefit verification to insurance discovery for accounts with unverified eligibility, further optimizes the workflow.

How Verification of Benefits Ensures Cleaner, More Accurate Claims

An accurate claim submission starts with verifying a patient’s insurance coverage before the appointment. Hospitals can ensure they submit clean claims by confirming that the provided demographic and insurance details are correct.

Elements to verify include: 

• Patient policy status and effective dates (including deductible reset dates)
• Coverage for specific services
• Patient financial responsibilities (including deductibles, coinsurance and copays)
• Prior authorizations
• Any special clauses that may impact coverage
• Network status of your healthcare facility

Reduce Denials

Claim denials are a major obstacle to a healthy revenue cycle. Many denials stem from issues that could have been resolved with a proper VoB process, such as Incorrect or outdated patient insurance information, policy coverage lapses, or expecting payment for services not covered under the patient's plan. Verifying benefits first avoids these common pitfalls.

Increase Operational Efficiency 

Implementing an automated verification process is a proactive approach that ensures billing teams submit the correct information the first time. This process minimizes human errors and eliminates the need to track down missing information or rework a claim for resubmission. VoB enhances operational efficiency, reduces workload, and saves time so staff can conduct more rewarding, patient-focused tasks.

Predictable Cash Flow

Knowing your organization will receive reimbursement has many advantages. Budgeting and forecasting are easier, finances are more stable, and revenue streams are steady and reliable. VoB minimizes billing errors and increases first-pass yield to help support a predictable cash flow. 

Build Patient Trust 

In a worst-case scenario, confusion of VoB can impact patient care as teams work to determine whether certain treatments are covered. Knowing this information in advance and providing clear and transparent pricing information to patients up front enhances trust and satisfaction while minimizing the possibility of payment disputes for a less stressful healthcare experience.

How Insurance Discovery Makes Verification of Benefits Easier

Insurance discovery leverages automated searches and databases to identify missing or undisclosed insurance coverage. By conducting an exhaustive check of government and commercial payers, insurance discovery verifies existing coverage and flags any changes that may impact billing. 

This ensures hospitals are billing the correct payer, reducing the risk of uncompensated care and claim rejections. It requires minimal input from staff and reports sources of revenue via billable coverage that would otherwise go unpaid. 

Insurance discovery is not a one-and-done process. A cascading process that begins with standard benefit verification and transitions into insurance discovery for unverified accounts ensures a thorough and efficient approach to insurance validation.

Best Practices for Verification of Benefits

To maximize the effectiveness of the VoB process, hospitals should consider the following best practices:

• Utilize technology to streamline VoB and insurance discovery, reducing manual errors and administrative workload.
• Conduct VoB at scheduling, pre-registration and check-in to ensure the most up-to-date information.
• Validate patient demographics to ensure accuracy and prevent mismatches that could lead to claim denials.
• Inform patients of any coverage concerns before their visit to avoid surprises and facilitate upfront collections.
• Track VoB-related denials to identify trends and improve the verification process over time.
• Maintain detailed documentation about verified insurance information for future reference and auditing purposes. 
• Update patient records promptly when benefits are verified. Include information on coordination of benefits. 
• Inform the patient of their financial responsibilities in writing and receive a signature acknowledging receipt of these responsibilities.

Common Mistakes in Verification of Benefits

Even with a strong process in place, hospitals can still encounter issues if they fall into these common VoB pitfalls:

• Relying solely on manual verification, which can be time-consuming and prone to human error, leads to incorrect claim submissions.
• Delaying verification until after services are rendered. (What if the services aren’t actually covered?)
• Failing to verify secondary sources of coverage.
• Failing to verify patient information or collect information at the time of registration.
• Ignoring updates to insurance plans and coverage terms.
• Failing to understand complex or frequently changing insurance coverage. Often, identifying and addressing the reason behind the tumult can smooth the process. 

Using Office Ally’s Discovery Tools for VoB

By ensuring accurate insurance information upfront, providers can reduce claim denials, accelerate payment collection and improve overall financial health. When combined with insurance discovery tools, VoB becomes even more effective, allowing hospitals to identify missing coverage and capture additional revenue.

Office Ally’s Insurance Discovery solution is one of the most affordable, reliable and uncomplicated tools for finding insurance coverage and verifying benefits. Move confidently into commitment and ensure Insurance Discovery will yield returns for your organization with a free assessment. 

To start, Office Ally only requires a BAA, a secure HIPAA-compliant web portal or SFTP and a target data file. The process usually takes 2-4 hours of staff time to implement. In 7-10 days, you will receive a detailed assessment report to validate the quality of findings. If additional revenue opportunities are found, providers benefit from improved revenue recovery. If not, the free assessment confirms that existing systems perform optimally, offering peace of mind without financial risk.

If you’re considering auditing your current process or confirming the efficiency of existing insurance discovery vendors, Office Ally can help you verify that your system has the most robust solution in the marketplace. 

Learn more about Office Ally’s Insurance Discovery tool and schedule your free assessment here.