Three tips to streamline the patient eligibility verification process in your medical practice
Expired insurance coverage is one of the most common reasons why payers deny claims. The good news? It’s one of the easiest errors to fix. How? Patient insurance verification.
In this dynamic economy, patients change jobs frequently which means their insurance coverage changes as well. Other times, they may switch plans by choice, become eligible for Medicaid or Medicare, or purchase a supplemental plan. Multiply these changes by the number of patients in an average medical practice, and it’s easy to understand how patient insurance verification can easily overwhelm staff. The good news is that medical practices can—and should—take steps to streamline healthcare eligibility checks to maintain an up-to-date medical billing database.
Verifying patient coverage helps practices and patients alike. Here’s how.
Performing healthcare eligibility checks benefits providers in the following ways:
When medical practices verify patient coverage, providers can also estimate the amount patients may owe for any services they receive. They can also ideally collect that amount at the time of service. In addition, providing price estimates is an important part of complying with the No Surprises Act. Eligibility verification promotes financial transparency that can ultimately enhance patient trust, empowerment, and engagement as well.
Patient eligibility verification helps medical practices identify and obtain any necessary prior authorizations before patients present for the service. This can greatly assist with denial reduction and help ensure patients receive timely services. All of this promotes greater patient satisfaction and even improved outcomes.
Healthcare eligibility checks promote higher clean claim rates and better cashflow because medical practices bill the correct insurance the first time around.
Verifying eligibility helps improve patient access. For example, if a patient presents for an appointment only to find out a certain procedure isn’t covered—and then decides to cancel—that’s a missed opportunity to help a different patient who could have taken that appointment slot instead.
Insurance eligibility verification benefits patients in the following ways:
Healthcare eligibility checks help patients anticipate and plan for their financial responsibility. This can greatly ease stress and anxiety related to unanticipated medical bills.
When medical practices verify patient coverage, it gives patients the opportunity to ‘shop around’ and potentially find lower-cost alternatives (e.g., different care settings or in-network providers).
Insurance verification helps patients understand their own benefits. It often isn’t until a patient uses their insurance that they begin to realize how it works, what’s covered, and how much services will ultimately cost them. A medical practice can serve as a trusted educational resource and help patients navigate the complexities of their policies.
Streamlining patient eligibility verification
Following are three ways to improve healthcare eligibility checks and simplify the process to verify patient coverage:
1. Collect, verify the patient’s demographic and insurance information at the time of scheduling. Then verify coverage while the patient is still on the phone. The key is to use technology that enables real-time eligibility checks. Today’s busy medical practices don’t have time to log onto multiple payer portals or wait on hold on the phone to verify coverage. The good news is that they don’t need to. That’s because real-time eligibility software provides this information instantaneously.
Here’s how it works: Real-time eligibility software gathers important data (e.g., patient name, date of birth, address, Social Security Number, insurance carrier name, and insurance carrier ID number) from the provider system and sends it to the payer’s system. The software application then authenticates the payer’s response and provides eligibility information back to the provider. This includes information about coverage dates, type of coverage, copayments, deductibles, referrals, prior authorizations, lifetime maximum, in-network or out-of-network status, durable medical equipment coverage, and more.
2. Update insurance information at every visit. Front office staff often make the grave mistake of simply asking patients whether they have the same insurance rather than actually looking at their insurance card. Patients aren’t always the best historians, which is why it’s important to look at the card and make a photocopy or scan it into the medical record. Then perform another eligibility check on the date of service to ensure the patient’s coverage is still active.
3. Incorporate patient education. Medical practices often overlook one simple way to streamline the eligibility verification process: Partner with the patient. For example, when patients know they need a referral, they may be more likely to obtain it on their own. Likewise, when they understand the importance of providing accurate insurance information, they may be more likely to come to their appointment prepared with updated insurance cards. When staff make it a goal to focus on education, patients will become accustomed to playing more of an active role in the financial aspect of their care.
Conclusion
Improving healthcare eligibility checks doesn’t require a massive overhaul of medical processes and procedures. Small changes can have a big impact. Learn how edgeMED can help and be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
