{"id":287,"date":"2021-06-26T13:16:53","date_gmt":"2021-06-26T07:46:53","guid":{"rendered":"https:\/\/www.eclaimstatus.com\/blog\/?p=287"},"modified":"2021-06-26T13:16:53","modified_gmt":"2021-06-26T07:46:53","slug":"the-importance-of-patient-eligibility-verification-in-revenue-cycle-management","status":"publish","type":"post","link":"https:\/\/www.eclaimstatus.com\/blog\/the-importance-of-patient-eligibility-verification-in-revenue-cycle-management\/","title":{"rendered":"The Importance of Patient Eligibility Verification in Revenue Cycle Management"},"content":{"rendered":"

\u201cPrevention is better than cure\u201d, a 17th Century proverb that has it\u2019s roots in the medical profession is now finding a stronger calling in the same profession albeit for a different reason.<\/p>\n

Recent reports shows that \u201cclaim denials\u201d are on an upward trend putting your cash flows into jeopardy. Quite different from rejection that happens due to lack of right data or codes or as simple as a patient\u2019s insurance policy number, denials are generally received and processed by the insurance company but stamped as \u201cnon-payable\u201d. Denials add to the ever-expanding gaping hole in your revenue calculations.<\/p>\n

While the losses can be colossal, they are potentially \u201cpreventable\u201d. A detailed root cause analysis of such claim denials can help you find the earliest stage a denial could have been stopped before it happened. And, that’s the first win against this malady.<\/p>\n

Let\u2019s look at one of the key contributors to this damage and how you can prevent it from happening in the first place.<\/p>\n

One of the earliest stages of prevention is through a patient\u2019s eligibility check<\/a>. An eligibility check requires verification of patient\u2019s insurance<\/a> with their demographic essentials, coverage status, authorization, and similar details that prove the patient\u2019s eligibility for the needed treatment. A simple error of checking eligibility during an appointment rather than during an actual visit can lead to a probability of error.<\/p>\n

\"Patient

Patient Eligibility Verification in Revenue Cycle Management<\/p><\/div>\n

Key ways to strengthen the patient eligibility check process include<\/strong><\/p>\n

Audit and Train:<\/strong> Knowing what processes are currently employed at present to verify a patient\u2019s eligibility<\/a> is the first step that you need to do. Once you know these processes, a careful review of each step needs to be done. Common mistakes are known to occur due to inefficient processes. Regular training programs to staff on eligibility verification can keep maintaining checks on the practice.<\/p>\n

Leverage Technology:<\/strong> It\u2019s probable that from the audit you would gather some steps which are manual and mundane. A manual process carries a huge probability of getting things wrong. A few of the areas where technology can play a key role are:<\/p>\n