Why is Patient Eligibility Verification Important?

You must have heard of the 17th-century proverb, “Prevention is the best cure.” This prover found its roots in the medical profession, and today it is finding a stronger calling in the same profession, but for a different reason.

Recent studies show that “claim denials” are rising, putting your cash flow at risk. Denials are received and processed by the insurance company and labeled as non-payable, unlike rejections, which occur due to erroneous data, incorrect codes, or the wrong insurance policy number in rare situations. Denials are worsening the ever-widening income gap in the revenue calculations of any practice.

While the losses may be massive, they may be “preventable.” A thorough root cause analysis of such claim denials and an efficient patient eligibility verification process will help you determine whether a denial could have been prevented in the first place. That’s the first victory overall in this problem.

Why is medical insurance eligibility verification crucial?

In any practice’s claims denial management program, insurance verification is crucial. The effectiveness of eligibility verification is the sole factor for successful billing. In a nutshell, health insurance verification is checking with an insurance company to see if a patient has active coverage. It also confirms that a patient’s insurance claims are valid.

It is vital to verify a patient’s insurance before being admitted to any hospital, clinic, or medical facility to avoid claim rejection. However, filing for claim rejection is a nuisance and consumes time and resources. Instead, verify that the written patient information is accurate and current. 

Make sure that the policies are active and haven’t been changed. A claim rejection or denial can come from even the tiniest and most basic inaccuracy. So ensure you’re thorough and attentive.

Insurance eligibility verification- The best way to maximize reimbursements

An insurance verifier is a person who ensures that eligibility and benefits verification go smoothly. They are one of the most crucial members of the team. They interact with patients, handle all paperwork, and double-check patient information with their insurance carriers to improve the revenue cycle and maximize reimbursement.

Insurance verifiers ensure that the following items are checked:

• Payable benefits
• Co-insurances
• Patient Policy Status
• Type of Plan and Coverage Details
• Claims Mailing Address
• Lifetime Maximum
• Co-pays
• Deductibles
• Effective Date
• Plan Exclusions
• Referrals & Pre-authorizations

Process of patient eligibility verification

• Patient schedules are obtained from the hospital, clinic, or medical office.
• The front desk checks the insurance coverage of a patient.
• If further information is required, the front desk can contact the patients.
• Update the billing system with all eligibility and verification information, such as a patient’s insurance plan’s start and end dates, member ID, group ID, co-pay information, etc.

Why is outsourcing patient eligibility verification your best bet

A patient’s eligibility and benefits can change at any time. Failure to follow up with insurance carriers before a patient visit may increase claim denials and a significant revenue loss. In a healthcare facility’s claims denial management program, validating patients’ insurance eligibility is critical. 

Every thriving medical billing service is dependent on the verification of eligibility. Having a complete eligibility verification check at the healthcare desk saves time on the phone or many websites reviewing eligibility details. As a result, patient insurance eligibility is essential and plays a significant part in medical billing. 

With efficiency and unparalleled expertise, Capline Healthcare Management expedites the verification of each of your claims quickly and thoroughly. We are one of the best Insurance verification companies in the US, and we can help you with your ever-changing insurance eligibility requirements.