Patient eligibility and benefits verification is a determining factor in ensuring adequate revenue for healthcare providers and practices. This process involves checking the patient’s insurance coverage to establish if the healthcare provider will receive reimbursement for rendered services without any administrative hassle.
As patient eligibility verification is vital for revenue cycle management, understanding how to perform it becomes necessary. Also, healthcare providers must adapt to the ever-evolving insurance landscape to ensure overall efficiency.
Patient eligibility process management is essential for healthcare providers, highlighting the need to learn its nuances. In this blog, we will break down top strategies to streamline your patient eligibility verification.
By the end of this blog, you will know the best practices to optimize eligibility verification and enhance your revenue flow while handling billing operations proficiently.
Defining Patient Eligibility and Benefits Verification
Patient eligibility verification is a step in the medical billing process which involves verification of patient’s insurance coverage and benefits. This is to check if the services relevant for a patient are covered in the insurance policy or not. Not all medical procedures are a part of insurance coverage, and this prevents healthcare providers from achieving revenue for the same.
This verification is a testament to ensuring proper reimbursement to healthcare providers for their valuable medical services.
The verification step involves collecting patients’ insurance policy numbers, insurance company details, type of policy, deductible amounts, co-payment, and co-insurance. This information further helps in determining a patient’s eligibility, insurance coverage, and financial responsibility.
Frequent changes in the healthcare landscape affect insurance plans, highlighting the need for healthcare providers to stay up to date with changes. Healthcare providers must stay current with the latest guidelines and rules to avoid claim denials, delays in payments, and revenue loss.
The Critical Role of Patient Eligibility and Benefits Verification
Patient eligibility process management is a crucial step for healthcare providers as it ensures effective revenue cycle management. That is why there is a need for healthcare providers to perform this step thoroughly while maintaining the quality of patient care. When this step is handled properly, healthcare providers can be reassured that they will receive adequate reimbursement.
Let’s discuss some points that make patient eligibility verification processes significant:
Prevent Claim Denials & Rejections
Insufficient insurance eligibility verification results in claim denials and rejections affecting the revenue cycle of healthcare providers and practices. This is one of the most common challenges faced by healthcare providers and practices. In the case of claim denials and rejections, healthcare providers lose revenue. Even if they have proper denial management, refiling claims and recovering payments takes time and resources. However, precise eligibility process management helps healthcare providers secure adequate and timely reimbursement.
Elevate Financial Flow
Effective patient eligibility verification helps healthcare practices improve financial flow by streamlining claim filing and preventing denials. The verification process helps you evaluate your revenue cycle by analyzing if a patient’s insurance plan covers relevant medical services.
Enhance the Patient Experience
Accurate insurance eligibility verification simplifies the medical billing process and reduces the scope of unexpected bills for patients. Due to this, patients feel at ease and feel more satisfied with the healthcare services. Patients appreciate it when they are informed about their financial responsibility and out-of-network expenses in the initial stage. Such transparency makes patients feel that they have received quality services.
Improve Operational Workflow
Eligibility verification processes streamline the administrative process and upgrade the billing operations. Further, this helps reduce overall medical billing costs and reduce common errors in the process.
Important Aspects of Patient Eligibility Verification
It is clear that eligibility process management is vital for healthcare providers. Whether you handle billing yourself or work with a staff, you must understand some important aspects of patient eligibility.
Here’s the information that insurance companies require to check eligibility:
Subscriber information, patient’s name, patient’s date of birth, relationship between the patient and subscriber, gender, insurance policy number, plan type, and coverage date.
Other than the requirements, you must also identify insurance verification elements such as:
Co-pays, co-insurances, deductibles, payable benefits, the patient’s policy status, effective date, type of plan, coverage details, plan exclusions, claims mailing address, referrals, pre-authorizations, and many more.
As an informed healthcare provider, make sure you take care of these factors and aspects to enhance your eligibility process and acquire desired revenue.
Tips to Elevate Your Patient Eligibility & Benefits Verification
If you want to move a step further in boosting your patient eligibility verification process, then you must take care of these things:
Type of Eligibility Verification Processes
If you are only relying on manual insurance verification, then you are compromising the efficiency and accuracy of the billing process. Incorporating advanced technological tools not only reduces errors but also gets the work done in less time.
Going completely electronic may not be an option for all healthcare providers. So, if you feel the same, then opting for a blend of both can be beneficial. This will reduce complications related to the collection of insurance details and their verification.
Timely Processing of Eligibility
When it comes to the time of checking the patient’s eligibility verification, make sure you check it at least 48 hours before the patient’s visit. If this is not possible due to any circumstance, then check the eligibility at the time of the patient’s check-in.
There are benefits to being on time, one of which is reducing the scope of claim denials and rejections. If you utilize the electronic eligibility process, then this task will not require much hassle and time. However, doing this before rendering patient care is crucial to avoid denials and revenue loss.
Here’s a checklist for patient eligibility insurance verification:
- First, check if the insurance plan is active.
- Make sure to investigate any insurance changes from the patient.
- Ask your patient if he/she has multiple insurances of different kinds, namely primary, secondary, and tertiary. Also, ensure that the patient has COB with every payer.
- Don’t miss verifying the Medicare coverage for senior patients with the age 65 and above.
- Be proactive to realize the need of prior authorization and referral and obtain it before rendering services.
- Check the patient’s insurance policy thoroughly to ensure that it covers the recommended procedure.
- Determine the patient’s financial responsibility to ensure payment for deductibles, copayments, and co-insurance.
Why Outsource Your Patient Eligibility and Benefits Verification?
Patient eligibility verification is a complex process, but an outsourcing partner can help you navigate through it. Medical billing services can help save time on the administrative process and focus on improving patient care.
Medical billing services simplify intricate medical billing steps and help you achieve adequate revenue. When it comes to eligibility process management, medical billing professionals ensure thorough verification. They help you avoid common errors, prevent denials, and acquire desired reimbursement.
Eminence RCM—Your Ideal Outsourcing Partner
If you want to improve your patient insurance eligibility verification, then Eminence RCM can solve your problem.
We, at Eminence RCM, ensure a streamlined medical billing process with reduced errors, delays, and denials. Our team understands the requirements for eligibility verification and offers solutions based on your unique requirements.
When it comes to medical billing, we make sure all the steps are aligned, and you achieve adequate revenue. Our services are dedicated to maximizing your revenue, helping you simplify the complex operational workflow, and driving your bottom-line growth.
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