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Insurance verification software facilitates the process of confirming a patient’s or resident’s insurance plan during their stay at a nursing home. Because the number of managed care and insurance plans has increased—due to the increasing number of seniors and healthcare options—long term care facilities now must verify patients’ and residents’ insurance coverage more efficiently than before. That is why insurance verification software is usually part of an efficient long term care software system.

Prospective patients When a long term care facility is considering admitting a new patient, they will need to verify the patient’s insurance coverage. Insurance verification software can be used to confirm that the patient’s insurance plan will cover the cost of their care. This information is vital in helping the facility decide whether or not to admit the patient.

Current residents: Long term care facilities will also need to verify their current residents’ insurance coverage regularly. However, insurance plans are susceptible to change, making it crucial for facility staff to be vigilant and confirm whether a resident’s coverage has lapsed or been canceled.

The benefits of using insurance verification software include:

Long term care staff struggling with insurance verification, due to the lack of insurance verification software
One of the benefits of using insurance verification software is fewer denied claims for long term care facilities.
  • Fewer denied claims: When insurance coverage is verified before treatment is rendered, the facility can avoid billing for services that are not covered by the resident’s insurance plan. This can help to reduce the number of denied claims.
  • Increased resident satisfaction with the level of care provided in the facility: Insurance verification software confirms teams are providing the level of care that the patient’s insurance plan will cover. This can help to increase resident satisfaction with the facility, as they recieve efficient care with minimal interruption.
  • Improved resident care: By verifying insurance coverage using their nursing home software, nurses and other staff can re-direct their efforts to providing adequate care to residents without worrying about whether or not their services will be reimbursed. 
  • Accelerated cash flows: Most long term care facilities in the US are for-profit. When insurance coverage is verified before treatment is rendered, the facility can avoid delays in reimbursement from insurance companies, thus accelerating cash flows and increasing profitability.
  • More time for employees: The automation capabilities of insurance verification software mean less time is spent verifying a patient’s insurance coverage and more time is left to be with residents.

When a long term care organization decides to implement an insurance verification software program, leadership will need to train their staff on how to use this component of the long term care software system and also provide them with an insurance verification training manual.

What Is an Insurance Verification Training Manual?

An insurance verification training manual is a document that provides instructions on how to use insurance verification software to conduct patient and resident insurance verification. This manual—typically given to new MDS nurses or new care coordinators in a facility—covers:

  • Inputting patient information
  • Verifying insurance coverage
  • Generating reports
  • An overview of the insurance verification process and what long term care facilities can expect when using insurance verification software

Administrators should be sure to ask long term care software vendors for insurance verification training manuals. Some long term care EHR vendors offer free training modules to help ensure that a facility’s staff is adequately trained on how to use the software and conduct insurance verification. Facilities looking for a professional course certification in insurance verification can contact the Healthcare Financial Management Association, which offers a $59.00 course for healthcare professionals.

In the meantime, teams can refer to this sequence of tasks as a guide for using insurance verification software:

Long term care staff reviewing an insurance verification training manual.
Some long term care EHR vendors offer free training modules to help ensure that a facility’s staff is adequately trained on how to use the software and conduct insurance verification.
  • Obtain all the patient’s or resident’s demographic information (name, address, and insurance provider)
  • Make digital copies of the resident’s insurance card (copy both the front and the back)
  • Enter all the collected information into the long term care EHR
  • Check the resident’s eligibility for services by selecting the relevant benefit and service time in the insurance verification software
  • Identify:
    • The policy-holder
    • The effective policy date
    • Term date of the policy
    • Whether the resident has co-pay or co-insurance 
    • Resident’s deductibles or accumulations
    • Whether or not the service requires pre-authorization from the insurance policy
  • Use the insurance verification software to request authorization when necessary
  • Inform the resident about their coverage (whether or not it was expected and what services are covered)

By following the insurance verification process outlined above, long term care staff can ensure that they are providing the best possible care to their residents while also getting reimbursed for services promptly.

Contact us here if you would like to upgrade your insurance verification software.

6 Core Capabilities of Medical Insurance Eligibility Verification Software

When choosing a system for medical insurance eligibility verification, long term care facilities will need to make sure that they select the insurance verification software that best meets their needs. While each LTC EHR software vendor is different, their systems generally have these core capabilities in common:

1. EHR integration capabilities:

Insurance verification software must have the ability to integrate with a facility’s EHR system. This allows for a smooth and efficient workflow, as all patient and resident information will be stored in a centralized location that is easily accessible.

2. Real-time insurance eligibility verification:

It is clear that an effective insurance verification software will have the ability to provide real-time insurance eligibility verification. This means that the software can verify patients’ or residents’ coverage and benefits in real-time as soon as a patient or resident’s insurance information is entered into the system. This will help to save time and avoid any delays in care.

3. Error scrubbing:

Patient and resident information entered into insurance verification systems will not always be correct. It is, thus, essential that insurance verification software can identify missing information, identify documentation errors, and fix any errors that may have occurred. This will help ensure that insurance claims are accurate, reducing the denial of claims and ensuring that facilities are reimbursed in a timely manner.

4. Data re-submission capabilities:

If a claim is denied because of incorrect data input, the insurance verification software can re-submit the claim with the corrected information. 

Senior resident receiving care services after medical insurance eligibility verification
The best insurance verification software has the capability to automatically transfer data from the provider to the payor (insurance company).

5. Automatic data transfer from provider to payor:

In order for insurance companies to process claims, they must first receive the claim from the healthcare provider. The best insurance verification software comes with an insurance verification training manual and has the capability to automatically transfer data from the provider to the payor (insurance company). This saves time, as staff no longer needs to go through an Insurance verification checklist to prevent any data or information errors.

6. Pre-authorization capabilities:

Some insurance companies require that certain services be pre-authorized before reimbursing the provider. The insurance verification software can request pre-authorization for services and track the request’s status, automatically updating nursing home staff if a service is approved. This will help to ensure that providers only administer services that are covered by the patient’s insurance and that they are reimbursed for those services.

The Value of Insurance Verification Software in Verifying Resident Information

An effective insurance verification process ensures that facilities provide the care for which they are authorized while also getting reimbursed for the services they provide. Before choosing an insurance verification software, though, administrators must conduct research to ensure that they select long term care software with the features and capabilities they need. Above, we mentioned six of the core capabilities to expect. But organizations will also have to also meet and decide what exactly they expect to get out of this advanced technology. 

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast.

Elijah Oling Wanga