Verifying patient eligibility is becoming an indispensable process when it comes to billing patients, getting paid by insurance providers, and the overall management of practices’ revenue cycles. With the rise in high-deductible and cost-sharing insurance plans, more and more patients are required to make payments at the time of service, though many patients are unaware of that fact.
Eligibility verification—particularly when done in advance—solves this problem, allowing you to give important information to your patients before their appointments.
If you thought that medical coding and billing used to be a complicated process, it’s likely only become more complicated since the recent transition to ICD-10. In addition to this change, the recent growth in the number of high-deductible and cost-sharing insurance plans, as well as the Affordable Care Act, have likely also had some sort of effect on your revenue cycle.
The solution to managing all of these recent changes? Patient eligibility verification.
Even just a few years ago, verifying patient eligibility once a year was good enough, as most patients stuck with their insurance providers for the long haul. However, the market is changing, and more and more patients are switching over to higher deductible plans and plans based on cost sharing.
Today, a patient’s insurance information can change over night—which is why it’s increasingly important to regularly verify your patients’ eligibility. But when, exactly, should you verify patient eligibility?
For most medical practices looking to improve their efficiency and the care they provide to their patients, there is always room for improvement. But many times, deciding where to start can be the most overwhelming part.
Oftentimes, medical practices turn first to their front desk or office, as this is where the patient begins their experience.
Recently, insurance policies have been changing, putting more and more of the financial burden on the patient, in the form of copays and high-deductible plans. Because of this change and this increase in financial obligations that patients are faced with, it’s becoming more important for medical practices to verify each patient’s insurance eligibility–before the office visit, if possible.
Verifying patient eligibility before a patient sees a physician has a number of benefits, and overall will save your practice both time and money.
Most medical practices are looking for more ways to increase revenue and close the gaps in delayed payments. Added to all of the latest trends in financial management are new regulations and changes in patient payment dynamic. Understandably, many practice managers find the overload of information counterintuitive to making sound changes that will beneficially impact their bottom line.
Most practices have some sort of protocol for checking patient eligibility prior to appointments. While some still rely on manually checking patient eligibility via calling the insurance providers, few private practices can spare the man hours it take to verify coverage in this manner. For those who do maintain patient payment information in-house, there are a number of options. Most different modes of checking patient eligibility have their own benefits, as well as problems to overcome.
There are a number of options available to verify patient availability and all of them will more or less impact the revenue stream in a number of ways. One concern is in how well the mode of verifying the patient ahead of time improves the rate of payment from both provider and patient. Another consideration is in the amount of time employees spend in the verification process – for example, manual verification will cost more in employee time than electronic verification.