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Eligibility Verification is a Significant Denial Management Tool

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Eligibility verification is essential to successful medical billing

Why is Eligibility Verification Needed?

Providers lose thousands of dollars every year when services provided by them are denied as non-covered services by the patients’ medical insurance company. Usually, the providers know about these denials anywhere between 15-30 days after the services were provided. As a result, they end up billing the patient after 30 + days and need to spend more time, money and resources to collect the dues. If they are not successful in getting the money from the patient, it will usually be moved to a collection agency. This non-productive billing process can be elevated by adopting insurance eligibility verification.

It is standard for individuals or employers to change their insurance plans for various reasons. These frequent changes make it essential for the providers to have updated information on patient insurance coverage. Hence eligibility verification process has become a crucial step in quicker reimbursement. It reduces and, in many cases, eliminates denials. Thus insurance verification helps to increase provider revenues and weeds out uncollectible.

Helping Providers and Patients

Insurance benefits and eligibility verification helps the provider office to determine co-pay, deductible and out-of-pocket expenses prior to providing the services. This allows them to collect the co-pays upfront during patient visits. It also helps reduce claim rejections and reduces billing costs from incorrect data errors. Accurate data is the crucial first step to effective revenue cycle management. An efficient eligibility verification process clearly (i) simplifies the patient registration process, (ii) reduces claims rejections and (iii) increases collections.

Eligibility and benefits verification usually provides various information, including but not limited to Patient/Subscriber name, Effective date of coverage, Group Name, Plan Name, Co-Payment, Deductible, Co-Insurance, Authorization, Referral requirements and more. Further, it helps to determine the patient’s primary and secondary coverage.

Carrying out Eligibility Verification

This check can be carried out using various methods like physically calling the insurance companies, using payors’ online portals, and using private vendor verification tools. Many online verification services help to load the data directly into the practice billing software. Advanced technologies enable us to get real-time verification done within seconds. This helps register the patients quickly in the provider’s office and significantly increases patients’ office visit experience. It also improves overall cash collections and reimbursements for healthcare providers.

As a significant denial management tool, insurance eligibility and benefits verification

  • helps to submit a high percentage of clean claims to the payers. This helps in quicker reimbursements and timely patient billing.
  • Claims denied for no coverage and non-covered services can be reduced significantly.
  • Eligibility and benefits verification helps in getting the claims paid fully and quickly.
  • It ensures fewer denials, reduces AR days and increases cash flow for the practice.
  • It helps to lower claims billing costs and increases the financial bottom line for the practices.

Bristol Healthcare can assist you

Bristol Healthcare Services, a medical billing company serving physicians for over twenty years, will ensure that eligibility verification is done thoroughly for you. We know that check of insurance coverage plays a crucial role in any healthcare practice’s successful revenue cycle management. Let us assist you in increasing your revenue and expanding your practice.

Talk to an expert today!

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