What Are Advantages And Best solutions For Real- Time Eligibility Verification

Insurance eligibility verification is the first and most important process and plays a crucial role in revenue cycle management. Healthcare professionals or the billing team responsible for the eligibility process can use a checklist to review when the patient checks in for the first time. Healthcare providers can also utilize software to expedite the process and ensure everything runs smoothly when verifying the patient’s information.

What is Insurance Eligibility verification in the healthcare sector?

Eligibility verification is verifying the patient’s information to ensure he has certain healthcare insurance coverages. More often, the medical billing companies in the USA tend to submit the information to the clearinghouse and get all vital information about insurance details, including copay, coverage, and insurance coverage details. 

Benefits of Real-Time Insurance Eligibility Verification

Real-time insurance verification has many benefits; the most prominent ones are time savings and higher patient satisfaction.

Reduce Expenses and make the administrative process more efficient.

Electronic Eligibility verification 

Automated electronic eligibility verification seamlessly examines coverage and eligibility, cutting down on substantial manual effort. Contemporary mechanical systems enable you to enhance your workflow efficiency, minimizing redundant tasks such as manual rekeying and data verification.

According to a CAQH Index report, electronic verification can save 14 minutes per transaction with healthcare providers. Plus, there has been a cost savings of $12.8 billion and reported CAQH. 

Provide a Better patient experience

The electronic verification process offers a stress-free experience. With faster confirmation, make the confirmation process faster, reduce the chances of procedure delays, and reduce the cost. 

 Patients know in advance whether insurance covers multiple visits, copay, benefits limits, deductibles, and out-of-pocket expenses. Also, it enables the patient to receive the estimations and helps them make a payment plan, reducing the room for surprise medical bills and frustrations.

Minimize the denial rate and help the healthcare provider reimburse faster

Financial management of healthcare practice ( Medical billing, careful coding process, verifying the insurance details, is a significant burden on the shoulders of the healthcare providers. However, automated real-time verification minimizes manual processing and helps you submit a clean claim quickly. 

According to the case study, clinics have seen substantial improvement in revenue growth, reduced denials, and better revenue management over time with the usage of real-time verification processes. Watauga Orthopaedics, a private orthopedic surgery practice in Tennessee, switched to electronic verification and helped reduce the denial rate from 11% to 4%. 

Improve the Revenue Cycle Of The Healthcare practice

Delays in the verification places are the financial strain on the clinics. The longer it takes to submit the claim, the lower the chances for healthcare denials. When there are late submissions of denial, it also means you will need help with the pressure of payment collection. 

Suppose you want to reduce the risk of ad debt, improve the performance of operations and efficiency, and increase revenue. In that case, the accurate time insurance eligibility verification will play the leading role. 

Best Approaches for Efficient Real-time Insurance Eligibility Verification

According to industry experts, there are some guidelines and efficient ways to carry out the task with compliance and integrity. 

Reduce communication gaps

You can only exchange data with the insurance providers if you have the system and patient information. According to the law, you must have the contracts and enrollment forms that grant access and ensure that all these methods are safe and secure. 

Medical billers or healthcare practices also need patient consent to use the data. Further, you have to explain your approach to that data, i.e., how you will be using that data and for what purposes. 

Ensure accuracy in the data collection process

Verifying eligibility relies on accurate and up-to-date patient data. So, precise data collection can streamline the process and ensure no errors. 

Set triggers with the automation workflow process and some strict rules that help in the prevention of mistakes. In this way, you cannot submit the information once you tick each necessary block. Some advanced features can also include identity theft and execution of entry detection processes to prevent fraud and data overlap. 

Monitor KPIs

One advantage of contemporary solutions, particularly those incorporating machine learning capabilities, is data accessibility regarding your operational performance. Utilizing this data, machine learning software improves the tasks assigned to it. Moreover, you can leverage this data to identify workflow bottlenecks and optimize process efficiency.

For instance, tracking your clean claims rate as a primary Key Performance Indicator (KPI) can offer insights into the effectiveness of your eligibility verification process. Typically, a denial rate of 5% or lower indicates a well-functioning verification process.

Conclusion

Insurance Eligibility verification is a critical component of healthcare revenue cycle management. However, an inefficient process can cause high denials, lower reimbursement, and bad debt, ultimately leading to financial instability. Overall, real-time verification is a simple solution with a widespread impact on healthcare practice.