Importance of Eligibility and Benefits Verification

7 February 2022
importance of eligibility and benefits verification

While constant changes and frequent updates in the health policies prevail, the medical coding company needs to ensure that the patient is steered clear through a seamless procedure enjoying the maximum reimbursement on par with the new policy.
Eligibility and verification procedure is paramount to avoid reworks, higher errors that result in claim denials and customer dissatisfaction.

Why Is It Important to Verify the Patient’s Eligibility Benefits?

Among the cardinal tasks of front desk staff, verifying the patients’ eligibility for insurance and benefits is crucial before any clinical services are provided. It requires knowledgeable and experienced staff who can proficiently handle insurance issues and carry out the same processing with utmost precision.There are 4 main reasons you must verify the eligibility and benefits. They are

1. Better Profitability: The claim submission is clean when a proper and updated verification is carried out. There are lesser claim denials, which helps healthcare maintain its cashflows.

2. Fairly Reduced Claim Denials and Rejections:When the verification procedure is accurate and streamlined, submission of clean claims increases, which helps in reducing claim denials and rejections.

3. Efficient Workflow:The revenue cycle management of a healthcare organization is enhanced through insurance services. An efficient workflow paves the way for a pleasant patient experience and decreases claim denials fairly.

4. Higher Patient satisfaction:Automated appointment scheduling, proper and prior verification about the patients’ eligibility and benefits and streamlined eligibility procedure which avoids claim denials or resubmission, elevate the patient experience, and fairly increases the patient satisfaction levels.

When Will You Perform a Verification of Benefits?

Verification of eligibility and benefits is best done before any clinical services or before any medical care commences. Prior authorization is required for the patient to undergo the medical services. Failing to do the same becomes a major headache resulting in delayed payments or claim denials, subsequently affecting the revenue cycle.

What Are Some Potential Consequences of Failing to Verify the Insurance?

When a patient holds an insurance card and is covered, it is vital to collect and verify their insurance coverage details before any medical care is provided. If you fail to do so, you will be left with an unpaid claim either by the insurance company or a patient who cannot pay the bill within the time window. It would affect the health of the revenue cycle of the healthcare organization.

Eligibility and Benefits Verification Process in Medical Billing

Healthcare providers can submit clean claims through the major help of a streamlined eligibility and benefits verification process. It plays a vital role in helping to avoid common errors. In turn, avoids claims resubmission and carefully validates the claim, thereby reducing claim denials and rejections. It enables receiving the upfront collections and elevates the patient experience to favorable levels, giving utmost patient satisfaction, enhancing medical billing.

How to Verify Patient Eligibility and Benefits Seamlessly?

To make your medical coding and billing team highly effective, you can follow the below 5 steps to verify patient eligibility and benefits seamlessly.

1. Checklist for Insurance Verification:The front desk staff must ask the right questions while verifying the patients’ eligibility and benefits. Critical information like the Insurance ID and name, phone number, claim address, name of the insured person, their relationship, Policy validity date, details of the services covered, the coverage status, a note if any prior authorization certificate is required. Amount break up components need to be accurately collected and recorded.

2. Patient’s Insurance Card Copy Procurement:First and foremost, must collect a copy of the insurance card. A proper and updated copy of both the front and backside of the card is necessary in the electronic health record for future backup and reference if any errors occur while storing insurance information.

3. Get Connected to the Insurance Provider:It is always better to get in touch with the insurance provider to verify the information about the insurance card for each patient. Sometimes, even after the card has been issued, there are chances for changes in the insurance coverage data. You can do this by placing a call directly to the hotline provided in the card or case of larger payers; they can be pinged using your Integrated EMR and Billing system.

4. Precise Details Documentation:Ensure proper training is given to the staff to record patient medical records diligently. Even a single number messed up could result in a claim denial or delay the payment and at times result in a claim which could completely go unpaid.

5. Systematic and Periodical Follow-up With the Patient:In case any doubts or insurance clarifications arise, never hesitate to contact the patient. A simple phone call or email communication through the patient portal is efficient and helps you keep the patient informed in advance in case of any increase in out-of-pocket expenses.

Streamline and Steer Steady for a Seamless Insurance Eligibility and Benefits Verification Procedure:

Business integrity services have an adept team with years of experience and excellent understanding to help you streamline your Insurance Eligibility Verification procedure seamlessly. You can relax as we allow you to submit clean claims, maintain your cashflows, elevate your patient satisfaction levels and enhance your revenue cycle management.