Verification of insurance benefits

Verification of Insurance Benefits

Verification of insurance benefits (VOB) is the first and most important step in the medical billing process.  The VOB process is no longer a simple eligibility check.  There is a difference between verification of benefits and verification of patient insurance coverage.  It requires an experienced staff who work with you and who understand payer benefit systems to eliminate the risk of inaccurate, incomplete, or out-of-date information.

VOB is a process in which insurance benefits are checked for potential clients.  This process entails making sure their health insurance is active, the payments are up to date, finding out the deductible and maximum out of pocket, as well as a variety of other questions. It is a way to ensure the services that you render will result in payment from the insurance company It is really the first step in ensuring payment from both the insurance company and the patient.  This process can be done by someone in-house or it is often done by the outside billing company.

Verifying benefits for a new patient’s insurance is crucial.  By checking all the information needed you are limiting any surprises when it comes to the patient’s insurance coverage, or what is not covered.  Just because verification of benefits shows a patient is active, you need to dive deeper and see that the patient is covered for certain services.  Also, how much is the insurance company willing to pay for this service.  Billing cycles are typically a week behind, if a verification of insurance benefits isn’t completed properly you run the risk of caring for an individual without valid benefits and won’t receive any financial compensation.

Completing a VOB successfully will put you on the right path for your revenue cycle.  Your coding, billing, utilization reviews and, if needed, insurance claim appeals will be made easier by starting with a strong verification of insurance benefits.

Verify insurance benfits submit claim get paid

Understanding insurance benifits keeps your revenue safe

It is important to be prepared.  Insurance companies can be challenging and each and every one has different stipulations for each and every policy.  So, you should be prepared with information and questions specific to each insurance company.  This will alert you with any red flags that could create a problem down the road. Each VOB needs to include the insurance representative’s name and reference number for the call if that isn’t noted it will be impossible to appeal a claim later on.  The verification of insurance benefits call is recorded to refer to if needed during claim follow up or the appeal process.

Once verification of the patient’s insurance coverage is complete it needs to be documented accurately.  The information collected while verifying insurance benefits is used to determine if the patient will fit your practice.  VOBs are often referred to throughout the billing process and if not documented properly it can affect every stage of your billing cycle.  Just as each patient is an individual so is their insurance. In order to keep a successful billing cycle and reduce insurance denials be sure that you are not only verifying insurance benefits, but you are also verifying patient insurance coverage.