Medical Billing Services
Prior Authorization, Eligibility, and Benefits Verification Services
Let us verify benefits and eligibility before filing insurance claims. We don’t just process claims and manage denials in our medical billing services. We also make the claims process much easier by taking steps to verify benefits and eligibility ahead of time.
- Checking patient schedules
- Entering patient demographic information
- Verifying patient coverage
- Verifying patient benefits
- Initiating prior authorization requests
Start seeing more profitability in as little as 5 days
One phone call is all it takes to identify whether our services are right for your practice. We can start serving you in as little as one week.
Our Prior Authorization, Eligibility, and Benefits Verification Services
In order to reduce the risk of having a claim denied and then needing to refile costs valuable time. To avoid this, we check that a patient has the insurance coverage necessary for a particular claim to be filed.
Working with Adam on consulting for out of network benefits. I have been very impressed by professionalism and explaining of very complex & confusing issues in easy terms.
Prior Authorization
Prior authorization is when an insurance company gives approval for a treatment or medication prior to the patient actually receiving it. Obtaining prior approval from an insurance company can help to reduce any risk of the claim being denied later. The insurance company would have already approved that treatment.
Benefits Verification
Before treating a patient, we’ll check that their insurance benefits will cover that particular medication or treatment. Knowing in advance that a certain treatment is included in a patient’s coverage can also help to reduce the risk of a denial later on.
Coverage Verification
Coverage verification is different from benefits verification. Benefits verification checks what a patient’s insurance will cover. Coverage verification checks that the patient had valid insurance at the time of the treatment. The timing of insurance coverage plays just as big a role in determining a claim’s viability as whether or not a treatment is covered.
Data Entry Prior to Patient Visits
Ideally, as much of the verification process is completed prior to a patient visiting. This means coordinating with patient schedules and gathering insurance information for verification. Prior authorization may not be possible until the treatment is known, but as much verification as possible should be done prior to the patient’s arrival in order to speed up the collections process.
Get a more profitable practice
Increase collections by 15%
Inhouse Medical Billing
$1,200,000 revenue
– $45,000 biller salary
– $40,000 secondary biller salary
– $23,750 Benefits and Overhead @ 25% of salary
– $3,000 Cost of software and hardware for billers
– $1,200 Cost of Postage
$1,087,000 in net collections
Average billing expense of 10.25% of collected revenue
Outsourced Medical Billing
$1,400,000 17% increase in top line collected revenue
– $77,000 5.5% of collected revenue
$1,323,000 in net collections
Average billing expense of 5.5% of collected revenue plus the added collective revenue from outsourcing
Benefits of Prior Authorization, Eligibility, and Benefits Verification Services
Applying for prior authorization and verifying patient coverage and benefits can help to speed up the claims process. This means receiving collections faster and reducing the risk of a claim being denied by a payer.
Reduced Risk of Claim Denials
Obtaining prior authorization for treatment from an insurance company and verifying patient coverage can help to reduce the risk of the payer denying the claim. This ensures a timelier payout of collections you’re owed because you’ll know ahead of time that a particular treatment is approved.
Faster Collections
If we verify patient insurance coverage and benefits prior to their arrival at your practice, the time it takes to code and file a claim is greatly reduced. Outsourcing already decreases the amount spent in A/R by up to 19 days and this pre-approval and verification process contributes to the speed at which we can get you your collections.
Flexibility to Meet Insurance Company Requirements
We’ve worked with many different insurance companies. This means that we’re able to tailor our claims filing process to meet the requirements of each in order to maximize collections and reduce the amount of time it takes to receive them.
Testimonials
What our clients are saying
"Their expertise and dedication have significantly streamlined our billing processes."
Read MoreAmy H
"Moving my billing needs to Quest National has been the best decision for my business that I have made!"
Read MoreBridget Ratner
"Quest provides excellent customer service, billing and accounts receivable management."
Read MoreSimminate Green
"…saving our practice tens of thousands of dollars."
Read MoreMark Lowney
OB/GYN, Southcoast Health
"Worked with our existing software so that we didn’t have to make expensive changes"
Read MoreAriana C.
"Quest has made the process so transparent and allowed us to increase our profits"
Read MoreJoseph D.
"I was impressed almost immediately by their transparency and consistent communication."
Read MoreRoger Prescott
Administrator, Multi-Specialty Clinic
