The success or failure of each patient claim begins and ends in the front office. Why? Patient insurance eligibility verification is the first—and perhaps most critical—step in the billing process, and will lay the foundation for your entire revenue cycle process.
The verification of benefits has evolved well beyond deductibles and co-pays. It’s no longer a simple eligibility check; it requires an experienced staff that will work with you directly, and that understand the payer benefit systems to eliminate the risk of inaccurate, incomplete, or out-of-date information. As the healthcare industry grows and insurance carriers increase their rules and regulations surrounding coverage, today’s technology can help streamline the efficiency, accuracy, and timeliness of your initial billing process.
Up-front Patient Eligibility Verification
Up-front patient eligibility verification is highly important because it acts as the foundation of your revenue cycle process. Further, eligibility errors create a more significant number of reimbursement challenges than any other claim issue. You might want to consider verifying eligibility multiple times since insurance information can change so frequently; consider verifying when the appointment is made, right before the appointment is carried out, at check-in, and after the appointment is completed.
There are many important things to identify when determining eligibility. Be sure to at least check all of the following: beneficiary and subscriber verification, coverage type, deductible data, eligibility and benefits, and specific information regarding the provider and service, including hospice information, cap or threshold amounts, preventative services, home health PPS episode information, and coverage changes since the last inquiry.
Furthermore, technology-based processes are much more cost and time efficient than manual processes. Modern systems can instantly complete the tasks that used to take considerable manual effort. Verifying electronically can save you almost $8.00 per transaction, and some systems can even automate data retrieval from payer websites, providing you with more data for less effort, which is especially beneficial in the instances where eligibility providers don’t deliver the necessary data when needed.
Identifying Coverage Changes
Regularly-scheduled batch eligibility verification can help you proactively reveal discrepancies in patient coverage; monthly verification can also help providers with reoccurring patients to gain better reimbursement rates. Even more, automated change reporting with some eligibility technology vendors will mitigate the time spent digging through patient data to find eligibility changes. Advanced eligibility verification will report patients with coverage changes directly to you, with no effort spent on your part.
Coverage discovery is vital for your front-end team to find patient eligibility information that’s missing during patient registration. Unfortunately, patients that don’t have the coverage needed often can’t pay for the service. Automated coverage discovery tools help you guarantee payment for care that could go uncompensated in unfortunate situations. Further, good eligibility processes and advanced eligibility technology increase cash flow and efficiency in your staff, while decreasing rejections, denials, labor costs, and time in A/R.
Timely, accurate verification and eligibility processes are vital to a seamless admission/billing process; they mitigate the risk of denied claims and lost reimbursement as well as keep the payer accountable. If you’re looking for a partner to aid in collections and other critical medical billing and practice processes, is exactly who you’re looking for. is the end-to-end solution to help providers increase collections.