The 8 Best Practices for Verifying Patient Eligibility

Medical care providers must verify all their patient’s insurance coverages and benefits for each and every visit prior to the treatment.  This practice eliminates chances of error-making during the process of filing for insurance reimbursements. An efficient process of verifying patients’ insurance eligibility goes a long way in improving the insurance payments and minimizing the risk of claim rejections and delayed payments.

While the process of patients’ eligibility verification is time-consuming, it also requires skilled effort for execution. The entire process is divided into several stages and each stage requires expert intervention to be able to fetch the desired results and optimize the output.

Verifying Patient Eligibility

Verifying Patient Eligibility

Here are the 8 best practices that can make the patient eligibility verification process faster and more efficient.

  1. Collect data from everywhere: Patients’ eligibility verification process required collection, analysis, and utilization of all possible ways to verify the appropriate insurance coverage. Data is the key component here. You must identify all the sources for collecting valid information about the patients and their insurance plans. This can start from taking the information about the patient’s schedule or appointment, recording the information about their demography, insurance coverage, type of plan, data of commencement and expiry, the status of plans, information regarding copays and deductibles, patient’s responsibility, and insurance reimbursements.
  2. Conduct a rigorous data check: Data required in the eligibility verification process must be accurate and real time. A serious review of the entire data concerning these two aspects is essential. Old data or incorrect data or missing data can prove detrimental to the process’s successful execution. When such data is presented to the insurance company it is either straight away rejected or held over for long periods resulting in financial loss and affecting the account receivables.
  3. Carry out follow-ups to fill in the missing pieces of information: Once the data is collected and analyzed, it is imperative to identify the missing spots or blanks. Assess the sources that will fill in these and arrange for follow-ups on data gathering and verifying.
  4. Verify the patient information with payers: This is important to give you insights into any possible discrepancies in the information collected from the patients and as provided by the insurance payer.
  5. Seek pre-authorization approvals: it is better to be prepared with pre-authorization approvals whenever required to enhance the patients’ experience and ensure that there are no claim denials later in the process.
  6. Use real-time data analytic tools: To enhance the accuracy and speed of your data management referring to real-time updated data is a must. These tools will help you gain access various payers under one roof to get the real time benefit information about any patient at any point in time.
  7. Check on the patients’ knowledge about their insurance plans: it is important to know how much does the patient is aware of his insurance plans, coverage, and responsibility. Several times it has been observed that the patients remain oblivious to the changes introduced by the insurance provider. During the time of the payment when such surprises come up where the patient is left paying huge sums from the pocket, this affects the relationship and trust between the patient and the service provider. To overcome this, provider has to educate the patient about the out of pockets upfront prior to the treatment.
  8. Take professional assistance: Verification process is best executed by the experts. You can use professionals to carry out this task for you and engage your staff in other areas that require more focus and attention. The subject matter experts can handle every stage of the insurance verification process with utmost clarity, confidence, and competence. With the experience of dealing with multiple clients, the professionals can identify the gaps better and find better solutions to resolve issues faster.

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