Written by Ezra Samarista
In the developing healthcare scene of Phoenix, Arizona, health insurance verification remains critical to smooth operations and quality patient care. However, due to the city’s expanding population and reputation for quality medical care, patient volume and service demands have surged.
These unique challenges and complex policies and claims make health insurance verification even more challenging for healthcare facilities.
Thus, many medical organizations turn to healthcare business process outsourcing (BPO) and virtual assistants in Phoenix to handle their claims processing tasks.
This article discusses how outsourcing streamlines health insurance verification in the Phoenix medical scene.
What Is Health Insurance Verification?
Health insurance verification confirms that a patient has healthcare coverage and that their insurance provider will repay the medical services they need. This process can be done in different ways, including:
- Manual verification. This is a traditional way of verifying insurance. Healthcare providers call insurance companies to confirm a patient’s coverage.
- Electronic verification. With this verification method, healthcare providers use electronic systems such as electronic health record (EHR) systems, web portals, or third-party verification services to verify insurance.
- Automated verification. This is the most efficient way to verify insurance. It uses software to integrate insurance companies’ systems and automatically verify a patient’s coverage.
The optimal procedure to confirm health insurance coverage varies depending on the situation. For example, healthcare providers might have to manually verify a new patient’s insurance. Meanwhile, electronic or automated verification can easily handle the files of regular patients.
Six Ways Outsourcing Streamlines Insurance Verification in Phoenix
Improved Procedural Expertise
Most BPO companies have a team of health insurance verification specialists. These professionals are trained to acquire basic skills in the following:
- Insurance eligibility
- Data entry
- Privacy law
- Medical billing
- Hospital administrative duties
- Medical coding
- Basic medical terminology
- Customer service
BPO companies also train their staff to understand complicated insurance plans and Phoenix’s health insurance field. Medical facilities no longer have to worry about training support staff when delegating this process.
Third-party experts verify coverage to ensure patients receive timely information about their insurance coverage and financial responsibilities. Thus, outsourcing insurance verification helps healthcare facilities in Phoenix provide a faster patient onboarding process.
BPO providers employ specialized staff for insurance verification, making it easier for facilities to avoid inaccuracies and noncompliance with healthcare regulations such as the following:
- The Arizona Medical Practice Act (AMPA) regulates the practice of medicine in the state. It covers ethical standards that require medical facilities to provide competent care. It also includes patient insurance and benefit verification.
- The Arizona Hospital Licensing Act (AHLA) requires hospitals and clinics to inform patients of their estimated financial responsibilities before receiving care.
- The Arizona Nursing Home Licensing Act (ANHLA) requires nursing homes to provide patients with an estimate of their financial responsibilities before they move in.
- The Arizona Health Care Cost Containment System (AHCCCS) is the state’s version of Medicaid. AHCCCS strictly requires healthcare providers to ensure their patients know of their financial responsibility and receive the benefits they’re entitled to.
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the federal counterpart of AMPA. HIPAA protects the privacy of patient information by requiring healthcare providers to safeguard data from unauthorized access, use, or disclosure.
- The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires medical facilities to provide emergency care to anyone in need, regardless of their ability to pay.
- The False Claims Act (FCA) prohibits healthcare providers from submitting false claims for service reimbursement or requests from patients not eligible for coverage.
By outsourcing insurance verification, healthcare facilities in Phoenix can eliminate possible errors, claims denials, and legal complications. Thus, outsourcing allows for more efficient patient services while reducing the risks of legal fines and cases.
Secured Staff for Peak Season
During peak season in Phoenix hospitals and clinics, such as summer, outsourcing firms allocate dedicated staff for extra support. These additional professionals help manage verification backlogs.
Facilities can then ensure efficiency in processes, preventing delays in procedures and reimbursements and providing an excellent patient experience.
Breaking Language Barriers
Phoenix is a multicultural city with a 42.7% Hispanic and Latino population. Although they are predominantly bilingual, with English being one of their primary languages, some citizens still speak only Spanish.
Given this, it can be challenging for medical facilities to explain policies and limitations to non-English speaking patients. Luckily, some Phoenix-based BPO providers, such as Unity Communications, have offices in Spanish-speaking countries such as Mexico.
By outsourcing insurance verification to these types of firms in Phoenix, healthcare providers can ensure patients’ understanding of complex medical functions.
Increased Operational Productivity
Outsourcing leverages advanced technology for insurance verification processes, boosting this process for Phoenix healthcare organizations. These technologies include the following:
- Artificial intelligence (AI) and machine learning (ML) automate tedious tasks such as patient data collection, insurance plan identification, and eligibility and benefit verification.
- Natural language processing (NLP) extracts patients’s insurance information, such as policy numbers and benefits, from their medical records to improve accuracy and speed.
- Blockchain prevents fraud and protects the privacy of patient information by creating a tamper-proof record of insurance data.
Additionally, healthcare providers no longer have to allocate a budget for resources and materials when outsourcing health insurance verification, saving them money in the long run.
Enhanced Patient Care and Experience
Employing BPO services for healthcare frees up in-house staff from time-consuming and repetitive tasks such as health insurance verification. This allows them to focus on providing direct patient care and other essential core responsibilities.
Outsourcing offers reduced wait time, speedy reimbursements, efficient patient onboarding, and increased in-house staff to cater to patient needs. Thus, third-party health insurance verification undoubtedly improves patient care.
Why Is It Important to Confirm Health Insurance Claims?
Verifying patient insurance claims benefits patients and medical organizations alike. For patients, it ensures they receive medical treatment they can afford. For healthcare facilities, it ensures their medical staff receives the compensation they deserve after providing quality care.
Here are more ways streamlined health insurance verification benefits patients and healthcare providers:
- Resource allocation. Accurate insurance verification enables healthcare facilities to allocate resources effectively. It ensures necessary resources, including medical staff and equipment, are available on time to provide appropriate care.
- Patient awareness. Knowing the coverage of their insurance plans helps patients make better decisions about the treatment they want and need without incurring unexpected costs.
- Patient onboarding. Insurance coverage verification streamlines the onboarding process. Informing patients about their coverage and financial responsibilities in advance reduces wait time and enhances their overall experience. It also improves productivity among healthcare providers.
- Billing and reimbursement. Accurate verification ensures that healthcare providers bill the correct insurance companies, reducing the chances of claim denials and payment delays. This is particularly important in Phoenix, where prompt reimbursement is crucial for financial sustainability.
- Compliance with regulations. Phoenix’s healthcare facilities must adhere to federal and state insurance verification regulations, including HIPAA. Failure to comply can result in legal and financial consequences. Fines for noncompliance range from $100 to as much as $1.5 million.
- Fraud and abuse. Each patient spends $12,900 on average for healthcare. Affording and accessing quality care are much more challenging. This situation can lead to fraudulent insurance claims, affecting medical facilities and the entire healthcare system.
Challenges in Managing Insurance Verification Processes
Like most medical facilities, healthcare providers in the city still face issues when confirming health insurance claims. Below is a list of common challenges that outsourcing insurance verification helps Phoenix hospitals solve:
High Patient Volume
Some challenges Phoenix healthcare providers face can be attributed to the city’s growing population and status as a medical destination.
Additionally, the region experiences a seasonal influx, specifically during summer, when heat strokes and Valley fever are common. In 2021, more than 11,000 cases of Valley fever in Arizona were reported, with 8,498 patients in Maricopa County alone.
Handling insurance verification for that many patients and those needing other treatments can overwhelm in-house staff, leading to delays, errors, and denials.
Long Process Durations
Though more healthcare facilities are moving toward electronic and automated health insurance verification, some hospitals and clinics in Phoenix still rely on the manual process.
This traditional way of verifying insurance can be time-consuming and error-prone, especially for facilities with many patients and complex insurance plans.
Complex Insurance Plans
Some of the common types of health insurance in the city include:
- Employer-sponsored health insurance,
- Individual health insurance,
- Government-sponsored health insurance, and
- Short-term health insurance.
However, with the frequent introduction of new policies, insurance plans in Phoenix are becoming more diverse. Keeping up with the latest changes and regulations complicates the verification process.
Each plan has its own set of rules and requirements, some of which are difficult to understand, require prior authorization, provide limited network options, and even instate high deductibles.
Limited Staffing and Resources
Recruiting and retaining medical staff have recently become difficult for many healthcare facilities. Additionally, healthcare providers might lack the resources to streamline the verification process.
Thus, staff shortages, resource constraints, and the influx of patients in the city reduce efficiency in health insurance verification in Phoenix hospitals and clinics.
High Risk of Data Security and Privacy Breaches
Protecting patient data is a critical concern. With more and more healthcare facilities switching to electronic and automated verification processes, sensitive data has become accessible to authorized and unauthorized parties.
At the same time, manual verification also poses a threat to data security and privacy. Information shared through phone calls and faxes is not encrypted and, therefore, can be intercepted by unauthorized individuals.
Thus, medical professionals might face challenges ensuring these verification procedures comply with strict data security and privacy regulations.
Significant Potential for Errors and Denials
Errors in health insurance verification are inevitable. Though manual processes are more prone to mistakes, electronic and automated verifications can still be faulty and require human intervention.
Such errors lead to claim denials and delayed reimbursements. These consequences can be costly for patients and damage healthcare providers’ reputations. Healthcare BPO services help resolve such gaps.
What to Consider When Outsourcing Health Insurance Verification
The global healthcare BPO market is expected to expand at a compound annual growth rate (CAGR) of 13.6% in the next seven years. So if you are looking to outsource health insurance verification for your medical facility in Phoenix, you will undoubtedly find a suitable outsourcing partner.
However, hiring the first BPO firm you find is not ideal. You should list your top prospects and narrow the selection by comparing crucial details. Below are factors you should consider when looking for a healthcare process outsourcing firm:
- Track record and portfolio. Knowing which hospitals and clinics the provider has worked with gives you an idea of its expertise. Learning how versed they are in Phoenix laws and insurance types is vital.
- Reputation and reviews. You can verify the BPO firms’ expertise by reading reviews. Testimonials also help you paint a clearer picture of what it is like to work with the company.
- Compliance and security. Providers handle sensitive hospital and patient information when working with insurance claims. Thus, when outsourcing health insurance verification, make sure to work with a company that is 100% HIPAA-compliant, especially with the growing cyber threats in Phoenix.
- Pricing and transparency. Phoenix BPO companies (with or without operations in Mexico) provide a single service fee in U.S. dollars, so you do not have to worry about exchange rates. However some firms still charge additional fees for specific services, so ask about billing cycles, pricing structures, and other fees to avoid hidden charges.
As the healthcare industry in the city thrives, outsourcing health insurance verification becomes a strategic choice for Phoenix hospitals. Outsourcing ensures efficient and effective care. It also offers solutions tailored to challenges unique to the area, such as a high patient volume and complex insurance plans.
With trained teams, advanced technology, and a commitment to compliance, BPO companies can streamline operations, reduce errors, and enhance the overall patient experience.
Let’s connect if you’re looking for a reputable healthcare BPO firm to handle your health insurance verification tasks. Unity Communications has the experience and resources to help improve your processes.