05 Sep Best Practices for Patient Eligibility and Benefits Verification

Patient eligibility and benefits verification is an integral part of your revenue cycle management when it comes to invoicing patients, receiving payment from insurance carriers, and managing your end-to-end billing.

Healthcare providers must verify each patient’s eligibility and benefits before their visit to receive timely reimbursement for their services. Most of the claims get rejected because the patient is ineligible for the medical services provided to them. Regrettably, it is one of the most overlooked processes in the revenue cycle chain.

Verification of a patient’s eligibility and insurance benefits is one strenuous task that is performed by your front desk employees. From calling each patient’s insurance provider to receiving calls from the patients for scheduling their appointments, the eligibility and verification process is indeed a challenging chore that takes a lot of their time.

It is essential for your staff to verify the mode of payment that your patients will use. The majority of Americans have access to insurance. Therefore, it is important to confirm their patient insurance eligibility before offering any medical care. Failure to do so might result in their insurance company refusing to pay your claim.

To secure your payments and better assist your patients, you are required to adopt certain practices that will aid you in your verification process and augment the patient experience. Here are eight best practices for patient eligibility and benefits verification that you can follow to ensure that your procedures are as efficient as possible.

Gather the Necessary Information

When checking up on the patient eligibility verification, it is necessary to gather relevant information about the patient to confirm that they have the right insurance coverage. Here, data is the most important element. Obtaining patient insurance information involves more than simply inquiring about their insurance provider. Taking their appointment details, insurance coverage, type of plan, and insurance reimbursements can all be the initial steps in this process.

Conduct Follow-Ups to Complete the Gaps in the Information

Patient insurance eligibility can be a cumbersome process if not done the right way. To save yourself from gathering any false information, it is necessary to locate any missing spots or gaps that may hinder the efficiency of the process. These missing gaps may include inaccurate patient ID, wrong information on the insurance carrier, or coverage details. You need to gather the missing information and make plans for data collection and verification follow-ups.

Promptness of Eligibility Verification

Healthcare practitioners are required to perform patient eligibility verification at least 48 hours before the appointment. This can be done in real-time upon checking in as well. Some companies, such as Sypore, offer real-time check-in to healthcare providers to save their time. Accurate eligibility checks assist you in minimizing claim denials and rejections. If this step is properly conducted by experts, it may help in enhancing the insurance claim cycle and boosting your revenue.

The Documentation of the Process

The eligibility verification process differs amongst certain medical institutions. As a result, each institution needs to develop its protocols for verifying the benefits and eligibility. Once the information has been gathered, it must be documented or entered into your billing system for usage and future reference. This process must be performed promptly to avoid any inconvenience and hence ensure that the patients receive the best treatment and care.

Assure the Patient that Verification is for Their Benefit

Many times, a patient may become annoyed or raise objections when you ask for their insurance information. In such circumstances, you need to assure the patient that you are getting their insurance information to check their eligibility and make coordination with the insurance companies easier. This will eventually benefit the patients in the form of receiving the best treatment in time.

Examine the Patients’ Understanding of their Insurance Policies

It is important to understand how well-informed the patient is about their insurance policy coverage and obligations. It has been noted several times that patients continue to be unaware of the modifications made by the insurance providers. Sometimes, unexpected expenses arise during the payment process and the patient is forced to pay significant sums out of their pocket. As a result, it takes a toll on the relationship and the level of trust between the patient and the service provider. To avoid this, the medical staff must inform the patient in advance of the out-of-pocket expenses.

Consider Outsourcing from a Reliable Source

Why not outsource your insurance verification services to assist in reducing the strain on your front desk staff? Your claims can be appropriately billed and processed with the aid of an outsourcing firm. You should only hire professionals to ensure that your claims do not get rejected or dismissed frequently. There are certain companies, such as Sypore, that you can hire to handle your end-to-end medical billing.

How is Sypore the Right Choice for You?

Our staff electronically checks a patient’s insurance coverage for medical care using real-time eligibility (RTE). We undertake the job of obtaining the most recent information and making it available to your front desk employees before the patient visits the medical facility.

Insurance verification in medical billing is a complex phenomenon that can prove to be a disaster for you if mishandled. Therefore, you need a partner that impeccably understands your needs and provides premium healthcare services to lift that burden off your shoulders. Backed by extensive knowledge and cutting-edge software technologies, we have been assisting healthcare providers in streamlining their revenue cycle management and improving the quality of treatment offered to patients.

Reach out to us now to experience impeccable end-to-end medical billing services!