In the healthcare and behavioral health space, accuracy and efficiency are top priorities. To ensure patients receive the appropriate care without unnecessary delays or denials, providers, billing teams, and treatment centers all rely on seamless workflows. Unfortunately, one of the most important steps in the revenue cycle, Verification of Benefits, continues to be one of the most frustrating, time-consuming, and complicated steps. This critical process can make or break approvals, delays, or outright denials of services. From a financial and patient satisfaction standpoint, the impact of such a process on an organization cannot be overstated.
The Importance of Verification of Benefits
Before identifying the specific challenges to be addressed, it needs to be acknowledged why this step is so important. Verification of Benefits assesses a patient’s insurance coverage, determines which services are covered, and identifies the limits or exclusions to coverage. When they are done right, they eliminate costly claim denials, care delays, and provide patients clarity around their financial responsibility.
Nonetheless, this approach is not simple. Insurance policies can be complex, questions from insurers may not be answered, and teams can be working with tight time constraints. The outcome? Staff burnout, and patients left in the dark. Here, we will identify five key issues and discuss ways to mitigate them.
Challenge 1: Confusion About Payer Policies
The frustrating issue is conflicting information from insurance companies. Your staff may get one answer from a payer, then claim something totally different on the online portal. Some issues with a claim may stem from a simple requirements miscommunication on pre-auth, and clearly lead to a claim falling apart.
The remedy here is to ensure there is a record of every discussion with payers. When teams verify coverage, and especially if it is expected to be a complex case, they should be taught to record the name of the rep, date, and time of the call, and everything they were told, including details. Ensuring multiple methods of confirmation for things is called a cross-check. Training staff to ask very specific questions will most times eliminate the gray.
Challenge 2: Complex and Changing Policies
Insurance policies are not set and forget. Employers change insurance companies. Payers change what benefits and services are provided. Plus, policies change depending on what a patient’s plan covers. In the world of behavioral health and addiction treatment, insurance coverage tends to change wildly, even for two patients with the same insurance company. This ever-changing landscape leads to a lot of confusion around what services are covered and what are not.
The answer to this problem is proactive approaches. Systems must be built and implemented to track changes by primary insurers in a timely manner. There are also significant returns on investments in staff education, as team members will be faster to identify red flags. Lastly, a coverage checklist for key components that must be assessed for each patient serves to decrease the instances of overlooked information substantially.
See also: The Rise of Age Verification Technology: Protecting Digital Spaces in a Connected World
Challenge 3: Time-Consuming Processes
The staff members that underway the benefits process spend multiple hours on hold with insurance companies, passing through the various AI steps, and then closing invoices, or waiting for a final document. For facilities with multiple patients in the same time frame, this situation creates a bottleneck in admissions and increases waiting periods for families.
Technology and organizational methods can streamline the process. Automation of portions of the verification process can lessen the amount of manual work required. Certain systems check payer databases to offer real-time verification and updates. Assigning staff to focus solely on verification can improve organizational streamlining and ensure that the task is not pushed to the side when other assignments present themselves.
Challenge 4: Lack of Standardization
Standardization is a common issue in the healthcare verification process. Every insurer works and processes information differently, while each provider organization also works and processes information differently. This impacts the new team member’s learning, or when staff members on the same patient file are not coordinating with each other.
Developing internal standard operating procedures (SOPs) is the best way forward. Standardization will decrease the chances of errors by providing expected, scheduled procedures for each staff member or team. Written procedures, checklists for each verification process, and regular staff training will ensure that all steps are completed.
Challenge 5: Pre-Authorization Complications
One of the most annoying components of the entire process of verification is pre-authorizations. Many services, especially within the behavioral health and addiction treatment sectors, need pre-approval before treatment commences. Unfortunately, communication within this field involves unpredictable timelines, and those waiting for pre-approval documentation may start feeling the time pressures. Those waiting for urgent care may become even more anxious, adding to the difficulties of an already stressful situation.
In these cases, providers need to start the authorization process as early as possible. Pre-empting authorization documentation requests of payers helps avoid the annoying back-and-forth stemming from incomplete documentation. People working in the same industry often gain the trust of their peers/clients, which may lead to faster and more reliable service or assistance.
Moving Forward with Confidence
These challenges, while difficult, are not without resolution. Those providers willing to work on and improve verification can count on faster admissions, fewer claim denials, and happier patients. Combining the efforts of trained staff, effective processes, and proactive engagement is the most efficient way to accomplish this.
Verification of benefits can be the key to gaining access to healthcare. If this process is properly done, it can improve treatment planning, billing, and long-term recovery. Solving basic problems can improve an organization’s financial position while improving customer care.
The Bigger Picture
For behavioral health and addiction treatment providers, the stakes couldn’t be higher. Every denied claim represents lost revenue, and every delay can mean patients waiting longer for essential care. On top of that, patients need to know what their insurance will cover. Add to that the fact that patients need to know what is and is not covered by their insurance so they can make decisions about their care.
This is why the most successful organizations understand that verification is not just busywork—it is the foundation of the entire business. They create strategic workflows, educate their teams, and acquire systems that minimize mistakes and improve timelines.
Final Thoughts
Verification of benefits is a complex process. Organizations that streamline and focus their systems will be successful since they will provide their patients access to care without added delays.
To minimize the time and costs associated with verification and provide support to strengthen the revenue cycle, some partners may choose to work with Indigo Billing.
