Optimizing Insurance Eligibility Verification Process: A Step-By-Step Guide

The current healthcare landscape is more complex not only for the healthcare providers but for patients and payers too. A recent report shows that more of the insurance claim denials occur due to the gaps in patient health information like missing claims form, incorrect form filling and lack of pre-certification. In this article, we explain you about the process of optimizing healthcare insurance eligibility verification.

Insurance eligibility verification in your RCM process

Healthcare Revenue Cycle Management (RCM) is the process of managing the patient data and the financial status of the organizations. This involves handling Medical data and patient information, storage and retrieval as and when required.

The information provided by the Patient pertaining their personal and insurance payer needs to be verified for accuracy and completeness prior to rendering the service as this can directly affect your financial system.

This explains why Insurance Eligibility Verification needs to be the first step of your RCM process.

Before analyzing on the measures to Optimize Insurance Eligibility Verification, let us look down on the benefits and detriments of having or not having this process in our RCM flow.

Why insurance eligibility verification is important?

Revenue Cycle Management involves meticulous details and information that tends to change and vary upon any given situation. This ever changing nature of the Medical data inclusive of patient demographic details and insurance coverage information arises the need to be checked and analyzed per every patient visit and per every service rendered.

It is advisable for any Medical Billing Company to have stringent measures to ensure the information in the claims submission is accurate and complete to avoid claim rejection and denial percentage.

An effective Insurance Eligibility Verification team will ensure the following is confirmed prior to the procedure.

Confirm the patient details and coverage benefits during each visits. This eradicates claims denials due to any changes in the existing data or information.

Ensure the patients Demographic details are up-to-date.

Verification of Insurance Coverage and validity to ensure the procedure to be provider is covered

Prior Authorization and Referral numbers if required.

Patient’s responsibility, copay coinsurance and deductibles details are checked to be discussed with the patient to avoid surprise billing.

Verify if In- Network or out of net-work services so the medical team can get the patient’s consent as required.

RELATED: It’s Time To Deploy RCM Technology For Your Practice

Benefits of insurance eligibility verification

Insurance Eligibility Verification ensures efficient RCM process, thereby reducing the changes of claims denials and rejections. Proper verification also helps in curbing wanted write-off and make sure collection of patient responsibility upfront. Substantially, it assures increased cash flow and Efficient Work flow.

Measures to optimizing insurance eligibility verification

Optimizing or enhancing Insurance Eligibility Verification is essential part if your claims denial percentage is aggregated or if your medical claims reimbursement percentage has taken a hit of late. By optimizing the verification approach required results can be fetched without affecting the Client satisfaction and the bottom – line of your business. Here are some measures to Optimize Insurance Eligibility Verification process.

• Double check Patients Demographic details and Insurance Coverage details by checking Insurance web portals, calling the Insurance Company, Patient, verifying through emails etc.
• Ensure Patients data is cross checked for accuracy and edited with any updates or changes
• Cross check Fee scheduled with allowed amount to ensure your charges comply with the recent and updated charges per procedure
• Integration of patient scheduling with Practice Management system to ensure automation of upcoming schedules and appointments
• Advanced and automated tool can help reduce man-effort and increase qualitative and quantitative results.

About Vozo RCM

If you are ready to maximize your revenue cycle efficiency, Vozo delivers you the best patient focused RCM solution that helps your practice in increasing cash flow by managing denied claims and improving patient satisfaction. Schedule a free demo to connect with RCM experts today!