Every year, providers lose thousands of dollars when their services are denied as non-covered by the patients’ medical insurance company. Typically, providers learn about these denials 15-30 days after the services are rendered. As a result, they must bill the patient after 30 days or more and expend additional time, money, and personnel to collect the debt. If they are unable to obtain payment from the patient, the case is normally turned over to a collection agency. The adoption of insurance eligibility verification can improve this ineffective billing process.
Individuals and companies frequently modify their insurance coverage for a variety of reasons. Because of the frequent changes, it is critical that doctors have up-to-date information on patient insurance coverage.
As a result, the eligibility verification process has become an important step in obtaining faster reimbursement. Denials are reduced and, in many cases, eliminated. Eligibility verification boosts provider revenue while also weeding out uncollectible.
Prior to providing services, the provider office can establish the co-pay, deductible, and out-of-pocket charges by verifying insurance benefits and eligibility.
This enables them to collect co-pays in advance of patient visits. It also aids in the reduction of claim rejections and the cost of inaccurate data errors in billing. The first step to efficient revenue cycle management is accurate data.
Eligibility verification that is efficient certainly
- accelerates the patient registration process,
- Decreases claim denials, and
- Maximizes collections.
Patient/Subscriber name, Effective date of coverage, Group Name, Plan Name, Co-Payment, Deductible, Co-Insurance, Authorization, Referral criteria, and more are typically provided during eligibility and benefits verification. Eligibility checks can also aid in determining a patient’s primary and secondary insurance coverage.
This facilitates patient registration in the provider’s office and improves the patient’s overall experience. It also enhances healthcare providers’ overall cash collections and reimbursements.
Insurance eligibility and benefits verification are important denial management tools.
- Assists in the submission of a high percentage of clean claims to payers. This facilitates faster reimbursements and patient billing.
- Claims refused due to lack of coverage and non-covered treatments might be greatly reduced.
- Eligibility verification aids in the timely and complete payment of claims.
- It ensures that the practice receives fewer denials, decreases AR days, and improves cash flow.
- It assists practices in lowering claim billing expenses and increasing their financial bottom line.
If you decide to outsource insurance eligibility verification services, here are the key questions you should be able to answer before hiring the right company.
When you outsource the insurance eligibility and benefits verification process in medical billing to experts like WWS, you gain access to a team of professionals. They already know the red flags to look out for, the information they need, and what medical services are excluded from different plans based on their experience with thousands of patients. This results in less rework and quicker billing cycles. Pattern recognition for claim denials will eventually reveal the root causes of claim denials.