Patient Eligibility Verification

One of the most common denials practices face is “Member eligibility not found on this Date of Service” or “Patient eligibility not found with Entity”.  It is imperative that a provider verifies a patient’s insurance coverage before any services is provided. This small step could save the practice from a reduction in the revenue.

Verifying a patients eligibility by the practice before the service is rendered doesn’t just provide patients updated insurance information but helps in identifying self-pay patients as well. Submitting claims without verifying patient eligibility could increase your denial rate if the patient’s eligibility coverage with the insurance is not according to what is on the claim. Not checking the patient’s coverage with the insurance before filing a claim could result in

  • Delays in payments
  • Increased phone bills
  • Reduced reimbursements
  • Increase in AR Days
  • Timely filling write off (If the claim is not caught on time). To name a few

Prepare a checklist of information to look for when verifying insurance eligibility. Confirm the Member ID, Start and end date of Coverage, Lapse in coverage and Patient’s name as per ID Card. Make sure to verify benefits in case of Motor Vehicle Accidents. Rigorous verification of coverage results in one denial eradicated for the provider which in turn increases reimbursement.

You can make the patient eligibility verification process much simpler with the help of automation technology. Here are specific benefits:

  • You put in the patient ID, and the software will run the number to see if the patient’s insurance coverage is a match for the provider.
  • The consumed time reduces greatly, making the process a lot more convenient both for the patient and the clinician’s staff.
  • Patients do not like surprise bills at odd hours. So you can make sure that you inform them about any self-pay situations.
  • Automation combined with a well-integrated staff involvement will help you improve both your revenue cycle and patient loyalty.

Are you looking for options that will give you similar results? But you do not want to invest in a new system? Outsourcing is the best answer! Outsourcing partners like leading revenue cycle management companies offer these services at a much lower cost. You also need not invest much in the system or its maintenance. They will remain accountable to you for getting you the much-needed benefits.

We hope that this blog helped you know the basics of patient eligibility verification and how you can simplify the process. For more such updates on healthcare management and technology, please subscribe to our blog. Do not forget to subscribe to our social media pages to get regular updates!

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