Certified Revenue Cycle Representative (CRCR) Practice Exam

Which method do most major health plans, including Medicare and Medicaid, primarily use for verification?

1. Toll free verification hot lines, staffed around the clock

2. Electronic and/or web portal verification

3. Patient "verification of benefits" cards

4. A grace period for obtaining verification within 72 hours of treatment

The correct answer is: Electronic and/or web portal verification

The method primarily used for verification by most major health plans, including Medicare and Medicaid, is electronic and/or web portal verification. This approach offers several advantages, such as efficiency, speed, and accuracy. Integrating technology in verification processes helps reduce paperwork, minimizes the likelihood of errors, and allows for instant access to the most current information regarding a patient's insurance coverage and benefits. Furthermore, web portal verification systems are designed to streamline communication between healthcare providers and payers. These platforms often provide up-to-date details on coverage, copays, deductible amounts, and specific benefits associated with different types of care. As the healthcare industry continues to embrace digital solutions, electronic verification is becoming the standard practice for confirming patient insurance details, which enhances workflow and can improve the patient experience. In contrast, while hotlines and patient cards can still serve roles in the verification process, they are generally less efficient and more prone to delays compared to the robust capabilities offered by electronic and web-based systems. The grace period concept is also less practical in fast-paced healthcare settings, as timely verification is often critical to care delivery.