Patient Eligibility Verification – Why Is This Important..

The healthcare landscape has evolved, and one of the greatest changes is the growing financial responsibility of patients with high deductibles which require them to pay physician practices for services. This is an area where practices are struggling to gather the revenue they are entitled.

In reality, practices are generating approximately 30 to forty percent with their revenue from patients who may have high-deductible insurance policy coverage. Neglecting to check patient eligibility and deductibles can increase denials, negatively impact cashflow and profitability.

One option is to boost eligibility checking utilizing the following best practices: Check patient eligibility 48 to 72 hours prior to scheduled visit using one of those three methods: Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and exercise management solutions.

Look up patient eligibility on payer websites. Call payers to find out eligibility for further complex scenarios, like coverage of particular procedures and services, determining calendar year maximum coverage, or if perhaps services are covered should they occur in an office or diagnostic centre. Clearinghouses usually do not provide these details, so calling the payer is essential for these particular scenarios.

Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients with regards to their financial responsibilities before service delivery, educating them about how much they’ll have to pay so when.Determine co-pays and collect before service delivery. Yet, even when carrying this out, you may still find potential pitfalls, such as changes in eligibility because of employee termination of patient or primary insured, unpaid premiums, and nuances in dependent coverage.

If this all sounds like lots of work, it’s since it is. This isn’t to express that practice managers/administrators are unable to do their jobs. It’s that sometimes they need help and better tools. However, not performing these tasks can increase denials, in addition to impact cashflow and profitability.

Eligibility checking is the single most effective way of preventing insurance claim denials. Our service starts off with retrieving a list of scheduled appointments and verifying insurance policy coverage for that patients. When the verification is done the policy details are put straight into the appointment scheduler for the office staff’s notification.

You can find three options for checking eligibility: Online – Using various Insurance company websites and internet payer portals we check patient coverage. Automated Voice system (IVR) – By calling Insurance companies directly an interactive voice response system will provide the eligibility status. Insurance Provider Representative Call- If needed calling an Insurance carrier representative can give us a more detailed benefits summary for several payers when not available from either websites or Automated phone systems.

Many practices, however, do not have the resources to complete these calls to payers. During these situations, it may be suitable for practices to outsource their eligibility checking for an experienced firm.

Medi-Cal Eligibility Verification System

For preventing insurance claims denials Eligibility checking is the single best approach. Service shall start out with retrieving list of scheduled appointments and verifying insurance coverage for the patient. After dmcggn verification is done, facts are put in appointment scheduler for notification to office staff.

For outsourcing practices must check if the following measures are taken approximately check eligibility:

Online: Check patient’s coverage using different Insurance company websites and internet payer portal.

Automated Voice System (IVR): Acquiring eligibility status by calling Insurance providers directly and interactive voice response system will answer.

Insurance carrier Automated call: Obtaining summary beyond doubt payers by calling an Insurance Company representative when enough details are not gathered from website

Tell Us Regarding Your Experiences – What are some of the EHR/PM limitations that the practice has experienced with regards to eligibility checking? How often does your practice make calls to payer organizations for eligibility checking? Let me know by replying inside the comments section.