Medical practices must focus on ever changing patient eligibility verification process to identifying the right coverage and providing the best medical care to it’s patient. While the medical fraternity strives at providing appropriate and timely care, billing processes often take a backseat. The complex process of billing, keeping a track of eligibility, and filing (or re-submitting) the insurance claims can divert the attention of both; patients and the practice. Post a treatment if the insurance claim is delayed or denied, this can result in loss of revenue for the practice and bitter experience for the patient.
Patient Eligibility Verification Process
There could be several reasons for an insurance claim delay or denial but the most common one is the incompleteness of data related to patients’ insurance eligibility verification. Using correct data is indeed an important step in ensuring timely and full payments for the services rendered and providing a better customer experience to the patients. Patient eligibility verification can be a long and tedious process yet the most essential one.
However, by adopting the following ten measures you can streamline the process, making it fast and efficient.
- Start in advance: Patient eligibility verification process needs data management, analysis, and recording skills. The details regarding the patient who is going to avail a medical service or take a treatment must be gathered accurately much before the schedule of appointment or date of treatment. The time leverage can help you identify and fill in the information gaps, wherever these exist.
- Review, revisit, and reconfirm: Once the information regarding the patients’ demography and details of insurance plan is collected, you must review it carefully to identify errors, spot the gaps and check on the validity of data. You must use all the sources of data and channels for reconfirming the data before recording it.
- Record the data with supporting documents for future references: The data that has been gathered and reviewed now needs to be recorded in the database or Billing System for future reference and use. Maintain supporting proofs for the data for future reference. An example here could be taking a photograph of the Insurance ID card of the patient, front and back, and keeping it in your records. The data can be a ready reference in the future to avoid miss-spellings and other errors while entering the data.
- Assess patients’ understanding of the insurance coverage: many times your patients’ may not fully understand their insurance plans. You can help them understand the plan and offer treatment recommendations accordingly. This step can help avoid surprises for you and the patient in the future.
- Use technology-based platforms to perform Patient Eligibility Verification: Technology plays a vital role in streamlining and easing out a complex task. You can adopt technology-based platforms automate your Eligibility Verification process which enhance the efficiency and quality
- Try to embed real-time data into your system: Using real-time data tactics for data reference can go a long way in enhancing the accuracy and speed of completing the process.
- Estimating the patient responsibility and insurance payment: Calculate in advance what the patient might need to pay out of their pockets and how much the insurance would possibly cover. Share this information with the patient for transparency and trust.
- Identifying pre-authorization needs: Pre-authorization is required in several of the medical services. Identifying such cases and obtaining authorization approvals can help you ease your billing process, and reduce claim denials.
- Maintain data hygiene: Train your staff to keep updating the patients’ data proactively rather than reactively. This will help you maintain a ready-to-use database and considerably reduce the risk of errors.
- Outsource to professionals: Professional medical billing services companies come with the necessary experience and skill sets to streamline billing and improve efficiency. If you are not able to dedicate your existing staff or fall short of expert staff to manage this process, outsourcing the Eligibility Verification and Coverage identification process to professionals can be a great idea.
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