Insurance eligibility verification is the first and most important step in the revenue cycle management process. Every year millions of health insurance claims are denied because of the expiration of eligibility and inadequate coverage for the patient. An accurate and timely receipt of insurance coverage is impossible without proper verification. For healthcare organizations that function without a proper eligibility verification process, they could be losing millions and billions of dollars annually. This is due to an increase in errors during the claims submission process, which lowers the business revenue and increases the average days for Accounts Receivable. CoverMe’s insurance verification portal can help you with in-depth insights into the intricacies of the eligibility verification process. This article will also provide a comprehensive overview of the importance of eligibility verification. Read on to explore the details.
Insurance Eligibility Verification & Its Importance
By definition, eligibility verification is the process of verifying a patient’s health insurance in terms of coverage status, inactive or active status, and eligibility status. As the first step in the medical billing process, verification is crucial for outpatient, inpatient, and ambulatory care.
Eligibility verification opens the door to several other vital procedures that help the patient to receive their health insurance. A successful verification results in:
- Submission of clean claims by the healthcare provider
- Elimination of claims resubmission
- Fewer eligibility-related rejections
- Increased upfront collections
- Quicker and accurate medical billing
- Improved patient satisfaction
- Increase in the number of clean claims
- Fewer delayed payments, non-payment, and billing errors.
- Accurate cost estimates for patients
- Healthy revenue cycle
What happens during the eligibility verification process? A representative of the healthcare provider checks the patient’s coverage with the insurance company and verifies the authenticity of the claim. Verification should be done before clinical services are provided. It is mandatory for all new patients, patients who mention changes in their insurance coverage, and for all expensive treatments.
Apparently, a process of such importance needs to be glitch-free, hassle-free, smooth, and highly efficient. If you have trouble with eligibility verification, here are seven ways to improve it.
Effective Measures To Improvise Eligibility Verification
1. Prepare a checklist
When a person arrives seeking medical treatment, the front office staff should immediately collect the following information from their insurance card:
- Name of the insured person
- Relationship of the insured to the patient
- Insurance name and ID
- Phone number and group number
- Claims address
- Policy’s effective date and end date
- Status whether the insurance is currently active or inactive
- Whether the insurance covers the services, diagnosis, and procedures to be provided
- Whether your practice participates with the insurance plan
- Limitations and exclusions of the policy
- Documentations for billing
- Requirement of a referral or pre-authorization certificate for payment
- The amount of the patient’s co-pay and deductibles
All these details should be reviewed carefully to identify errors and gaps in the data. You should also check the validity of the data using all your available sources to reconfirm the data before recording it.
2. Use technology-based platforms
Leveraging technology to streamline and simplify eligibility verification is a brilliant option. CoverMe’s technology-based health insurance marketplace solutions can automate the entire process and enhance efficiency and accuracy.
You can record the accurate and verified data and supporting documents in your billing system and use them for future references.
3. Verify with the insurance provider
No verification is complete and safe without cross-checking the details with the respective insurance provider. This step is mandatory to avoid data-entry errors and mishaps. You can contact the insurance provider before importing the data into your medical record systems. Remember to cross-check every minute detail and get the facts straight before moving ahead.
4. Update accurate patient data
When updating the patient data, take extra care to ensure accuracy. Any issues found during the eligibility verification process need to be addressed to avoid denials since this would result in data errors. It may subsequently result in a delay of days or weeks in payment, or the claim may go unpaid completely, which is bad for any medical practice.
5. Utilize real-time verification opportunities
In this tech era, it is not ideal or practically sensible to be stuck with time-consuming manual verification procedures that overburden your front-office staff. Instead, you can adopt a real-time verification process through a single eligibility portal. This solution will help you coordinate and communicate with the payers and providers and enhance your workflow.
6. Educate patients about early payments
Engaging patients early on and educating them about their coverage and payment responsibilities will result in high efficiency throughout the revenue cycle. You can divide the cost of treatment into long-term and one-time services. Ensure you collect the payment at the time of service. With this procedure in place, you can protect your business from possible payment loss. You can also reduce the risk of inadequate benefit challenges after treatment has begun.
7. Train your staff
The very success of eligibility verification relies on the efficiency of your staff. Well-trained, well-informed, and experienced staff are an asset. Train your staff to maintain data hygiene by updating the data proactively rather than reactively. You will have a ready-to-use, reliable database instead of an error-prone one.
Outsourcing Fortifies Eligibility Verification
Having a solid verification process in place can root out many redundant, unreliable processes in your practice. However, overburdening your staff may not be the wisest decision. Instead, outsourcing your verification processes with a partner like CoverMe allows you to focus on productive tasks. CoverMe’s customized health insurance marketplace solutions will optimize your revenue cycle and give you better control of your business. We offer many innovative processes to transform your RCM performance and enhance patient care. Would you like to schedule a demo and see it for yourself? Give us your details, and we’ll get back to you.
