How does Insurance Eligibility Verification Impact Revenue Cycle?

Verifying patient eligibility can be done in a variety of ways. However, some practices still use manual verification, which entails the staff checking insurance coverage and calling the carrier to confirm all of the data supplied by the patient. This procedure may take some time, which costs the practice in man hours because the person may be working on more crucial projects. 

Changing to computerized patient verification techniques or outsourcing are two options that many practices are considering.

Improvements to eligibility verification include:

  1. For Insurance Company – Verifying a patient’s coverage information can be done on each insurance company’s web portal. However, professionals will need to get familiar with a range of platforms as each request a different set of information, necessitating the need to verify eligibility for each patient individually rather than simultaneously for many patients.
  2. For Intermediaries – A system that enables practices to assess patients’ eligibility for a wide range of insurance carriers in one place and on a single platform is available for enrolment. Workers only need to learn one system to do this operation can save them a tonne of time. For example, a provider’s web portal or manual research must be done in cases where an insurance company is not listed in the database.

Outsourcing insurance eligibility verification transfers all the administrative labor involved in verification to an outside organization with plenty of knowledge in the industry, many practices find that outsourcing is the best option. Often, they can complete the assignment more quickly and effectively, saving the office staff many hours of work.

The Effect of Insurance Eligibility Verification on Revenue Cycle

It is crucial for the smooth operation of healthcare facilities that all patient eligibility be confirmed before services are rendered, regardless of the choice a practice decides is the best for their needs. The length of time clinics must wait for full reimbursement for services is impacted by patient eligibility in a few significant ways.

By confirming coverage beforehand, the clinic can calculate the full amount of the patient’s financial responsibility. Patients are much more likely to arrive at appointments prepared to pay in full or to work out payment arrangements when they are advised of their expected balance in advance.

Inaccuracies concerning insurance coverage might occur among patients. Insurance information can be complicated and is undergoing rapid change. Many people are unaware that their deductibles have changed or that other factors affecting how much they must spend out-of-pocket have altered. Informing patients as soon as possible will help them plan for the additional expenses or work with the practice to establish a payment arrangement.

Most patients desire to make prompt payments for their bills. To prevent patients from receiving unexpectedly high bills, practices can assist patients by helping them collect all the information they require through patient eligibility verification.

Prior eligibility confirmation safeguards practices when policies have expired or don’t cover the services. Outsourcing healthcare revenue cycle management services provide comprehensive solutions that cover prior eligibility.

Need for Insurance Eligibility Verification

Most claim denials are brought on by improper insurance verification before care is provided. The initial and most important step in the medical billing process is verifying insurance eligibility and obtaining prior authorization. The insurance verification process is essential for all appointments, whether inpatient, outpatient, or ambulatory care. It will ensure that the hospital or doctor’s office is paid for the care provided and will aid in determining the patient’s responsibility, also known as their portion of the hospital bill, for those costs. Verifying a patient’s eligibility entails confirming their claims’ validity and whether the patient has active insurance coverage.

  • Before a patient is admitted to a hospital, sees a doctor, or receives medical care from a third party, the verification process must be completed to prevent claim rejection
  • Coverage and eligibility should be checked for all new patients admitted to hospitals
  • Any patient who reveals a change in insurance
  • For all high-value treatments

Many non-emergency medical procedures and services call for mandatory verification and authorization. Many medical experts struggle to perform such crucial activities on time because they juggle patient care with practice administration. In this situation, our experienced staff can help. Outsource your verification and authorization operations to a trusted provider and take advantage of the service’s many advantages. 

Insurance eligibility verification services to help you:

  • To reduce denials and rejections
  • To resolve non-payment difficulties.
  • Further insurance mistakes

We are a leading provider of outsourcing Insurance verification eligibility services to clients all over the world Our verification specialists work with payers as well as clients to confirm eligibility and get authorizations for treatments or procedures to be delivered. They are versed in every facet of health insurance, healthcare terminologies, and medical/surgical practices.