Optimizing Healthcare Insurance Eligibility Verification: Getting Claims Accepted on the First Go!

The current healthcare landscape is more complex—not just for healthcare providers but for patients too. Studies show that most insurance claim denials happen due to gaps in patient information like—incorrect form filling, expired health insurance policies, missing claims form, lack of pre-certification, among many others.

In this complex scenario, it is critical that care providers rethink their revenue cycle strategies to make the insurance verification process more effective. In this article, we will discuss the key tactics to improve healthcare insurance eligibility and maximize your revenue cycle performance.

Questions:

1. Why opt for insurance eligibility verification?
2. What are the key obstacles?
3. How to overcome the challenges in eligibility verification?

1. Why opt for insurance eligibility verification?

Insurance eligibility verification is amongst the key processes in the overall revenue cycle management-as it has a direct impact on claim denials and payment delays. An ineffective insurance eligibility verification process affects all the aforementioned areas-disrupting reimbursements, revenues and the entire revenue cycle process.

Confirming the insurance coverage facilitates claim acceptance on the first go, whereas non-verification leads to several inconveniences like decreased patient satisfaction, increased errors, claim delays and denials. A strategic and step-by-step verification process is key to reducing claim denials and A/R days.

2. What are the key obstacles?

The Centers for Medicare & Medicaid Services (CMS) report reveals that about one third of claims are rejected on the first submission, and a whopping 67 percent of physician practice revenue is lost due to billing leak. Also, studies show that ineffective insurance eligibility verification process is amongst the top five reasons for claim denials.

Two of the key reasons for claim denials include-incomplete eligibility verification forms and invalid insurance coverage under a specific plan for the patient. Sometimes the in-house staff responsible for insurance verification may be overwhelmed with high-priority tasks like-documenting patient check-in and checkout, addressing patient concerns, scheduling appointments and multiple other tasks, which may lead to manual errors. Essentially, the primary reasons for claim denials include inaccurate claim submissions and failure to update the existing insurance coverage details. This in turn leads to delayed reimbursements, reduced cash flow, increase in A/R days that affect the entire revenue cycle process.

3. How to overcome the challenges in eligibility verification?

Our Medical billing service team experts at SolvEdge recommend 6 techniques that can optimize your insurance eligibility verification process.

Automate appointment scheduling through an advanced appointment scheduling software
Increase financial transparency and educate patients about coverage
Cross-verify patients’ coverage with payers beforehand
Update critical patient information including—co-pay, claim details, insurance coverage period, etc.
Ensure continuous follow-up to identify new and emerging issues on insurance eligibility-to prevent claim denials or delays
Enable real-time verification to quickly update and store patient data

SolvEdge’s Winning Edge Strategy to Maximize Eligibility Verification

At SolvEdge we understand that insurance eligibility verification can make or break the overall medical billing process. Our comprehensive strategies are designed to

Help increase revenues
Minimize delays and denials considerably
Improve collections by reducing write-off

Insurance eligibility verification process at SolvEdge

We receive patient schedules via EDI, email, fax or check them every day using our appointment scheduling software
Verify patients’ insurance coverage with primary and secondary payers by following up with payers and monitoring through the authorized online insurance portals. We also contact patients for additional information, if required.
Update the medical billing system with eligibility and verification details such as member ID, group ID, coverage period, co-pay, deductible & co-insurance information and, other code level benefits information.
Any new issues regarding a patient’s eligibility is instantly intimated to the client.

SolvEdge’s dedicated insurance eligibility verification team is equipped with well-trained, certified and experienced staff (5+ years of experience on an average) as we leverage cutting-edge technologies, strategic processes and industry best practices-to significantly reduce claim denials, A/R days, and ultimately optimize the revenue cycle process.

To learn more about how SolvEdge can help your organization streamline and maximize your eligibility verification process, talk to our team.

Optimizing Healthcare Insurance