4 Ways to An Efficient Insurance Verification Process

For healthcare providers, patient eligibility verification is the first and the most crucial step in the revenue cycle. An inaccurate eligibility assessment to determine the responsibility of the patient and the payer would lead to financial losses for the provider. As the majority of the denials are due to the expiration of the patient’s eligibility for services, providers must have a robust insurance eligibility verification process in place.

Here are a few proven ways to an improved insurance verification process

An Extensive Checklist

The front office staff of the care facility must follow an all-encompassing insurance verification checklist that would help them collect all relevant details about the patient’s coverage. The list must delineate the steps for amassing and verifying relevant information such as insurance name, ID number, group number, contact details, claims address, and effective and end dates. It’s important to check for the validity of the coverage and if the care facility participates in the plan. If there is a need for a referral or pre-authorization certificate of medical necessity, the same must be recorded and conveyed to the patient. The staff must also check the patient’s co-pay and deductible amounts.

Leverage Real-Time Eligibility Verification Possibilities

With technology evolving significantly over the years, providers are looking beyond the conventional ways of insurance verification through phone calls and payer portals. Today, they can execute the task electronically in the real-time, saving themselves from tedious manual processes. For this, the provider staff uses a single eligibility tool that facilitates unhindered communication with payers and answers all eligibility questions in a matter of seconds. Using an efficient real-time insurance eligibility verification tool, providers can establish smooth information flow with Medicare, Medicaid, and private payers.

Use Patient Eligibility Portals

Real-time verification of patients’ insurance coverage using an eligibility portal is one of the most efficient ways of saving time and simplifying the process. Such a portal allows providers to store and access eligibility transaction history and resend prior eligibility requests. A digital system like this eliminates the need for the provider’s staff to manage the plethora of forms and other paperwork to input and store patient information, thus resulting in patient satisfaction and a reimbursement rate.

Convey Patient Responsibilities

It’s important for a provider to educate the patient on their share of the payment responsibilities for the treatment planned. For an efficient revenue cycle, they must offer a detailed estimation of the cost and collect the payment at the time of the treatment. This cuts down on the risks of revenue loss for the provider and inadequate benefit challenges once the treatment starts. Additionally, it increases the likelihood of the patient completing the care which that improves their health.

For care providers, focusing on their medical insurance eligibility verification workflow with timely upgrades to expedite it and produce accurate results should be the priority. Seeking the services of a competent healthcare IT vendor would be a wise move to this end.