Significance of Eligibility and Benefits Verification

PractolyticsAugust 4, 2022

341 4 minutes read

Healthcare providers must confirm each patients benefits and eligibility prior to the patient’s visit in order to be reimbursed for the services provided. The medical coding services must make sure that the patient receives the maximum payment in accordance with the new policy while the health policies are subject to frequent revisions and updates.

In order to avoid reworks, greater errors that lead to claim denials, and unhappy customers, eligibility and verification procedures are crucial.

Why is it necessary to establish the patient’s eligibility for benefits?

Verifying a patient’s insurance and benefit eligibility is one of the fundamental duties of front desk workers before any clinical services are offered. It takes competent and experienced professionals who can efficiently handle insurance difficulties and complete the same processing with the highest accuracy. There are four key justifications for why you should confirm your benefits and eligibility. They are

Greater Profitability: When an accurate and recent verification is conducted, the claim submission is clean. Less claims are denied, which helps healthcare keep its cash flow steady.
Reasonably Reduced Claim Denials and Rejections: When the verification process is thorough and efficient, cleaner claims are submitted, which contributes to a decrease in claim denials and rejections.
Effective Workflow: Insurance services improve a healthcare organization’s ability to manage its revenue cycle. A smooth patient experience is made possible by an efficient workflow, which also reduces unfair claim denials.
Greater Patient Satisfaction: Automated appointment scheduling, proper and early verification of the patients’ eligibility and benefits, and a streamlined eligibility procedure that avoids claim denials or resubmission elevate the patient experience and fairly raise patient satisfaction levels all contribute to better patient experience.

When Will You Carry Out a Benefits Verification?

Before beginning any clinical services or medical care, it is best to confirm eligibility and benefits. For the patient to receive medical care, prior authorization is necessary. Failure to do so causes a headache since it can lead to claims being denied or payments being delayed, which then affects the revenue cycle.

When Will You Carry Out a Benefits Verification?

What Potential Repercussions Could There Be If the Insurance Is Not Verified?

Before offering any medical care to a patient who has an insurance card and is covered, it is essential to gather and confirm their insurance coverage information. If you don’t, either the insurance company or a patient who can’t pay the bill in time will leave you with an unpaid claim. It would have an impact on the healthcare organization’s revenue cycle.

Eligibility and Benefits Verification Process in Medical Billing

A streamlined eligibility and benefits verification services greatly helps healthcare providers in submitting error-free claims. It is essential in assisting with avoiding typical mistakes. Additionally, carefully validating the claim and avoiding claim resubmission reduce claim denials and rejections. Receiving upfront payments is made possible, and the patient experience is improved, leading to greater patient satisfaction and better medical billing.

How to Effortlessly Verify Patient Eligibility and Benefits?

You can follow the 5 procedures listed below to easily check patient eligibility and benefits, which will help your medical coding and billing team become more productive.

1. Checklist for Insurance Verification:

When confirming the patients’ eligibility and benefits, the front desk staff must ask the appropriate questions. The name of the insured person, their relationship, the policy’s validity date, the insurance ID and name, the phone number, the claim address, the specifics of the covered services, the status of the coverage, and a note if a prior authorization certificate is necessary are all crucial pieces of information. It is necessary to gather and record amount break up components with accuracy.

2. Patient’s Insurance Card Copy Procurement:

Obtain a copy of the insurance card first and foremost. For backup and future reference in case there are any mistakes made when recording insurance information, an accurate and current copy of the card’s front and back must be included in the electronic health record.

3. Establish a connection with the insurance company:

It is always preferable to speak with the insurance company to confirm the specifics of each patient’s insurance card. The insurance coverage information may occasionally change even after the card has been issued. You can accomplish this by calling the hotline specified on the card directly, or in the case of larger payers, you can pinged them using your integrated EMR and billing system.

4. Documentation with Exact Details:

Make sure the team receives the necessary training to meticulously document patient medical records. Even one incorrect number can cause a claim to be denied, cause a payment to be delayed, or occasionally even cause the claim to be paid in full.

5. Systematic and Repeated Patient Follow-Up:

Never be afraid to get in touch with the patient if you have any questions about their insurance. Simple phone calls or emails sent through the patient portal are effective ways to communicate with patients and keep them aware in advance of any increases in out-of-pocket costs.

Procedure for Verifying Benefits and Insurance Eligibility:

The skilled team at Business Integrity Services has years of experience and a thorough understanding of how to smoothly speed your insurance eligibility verification process. You may unwind while we enable you to file accurate claims, maintain cash flow, increase patient satisfaction, and improve healthcare revenue cycle solutions.