Reduce Claim Denials with a Proactive Approach to Eligibility Checks

Eligibility reports are a vital step in keeping healthcare practices profitable. Having a streamlined eligibility process will save your practice time and money, reduce the number of claim denials, and increase office productivity. With a thorough insurance eligibility verification process, your office can ensure that from the moment a patient makes an appointment, they are setting each claim up for success. 

Implore a recurring and consistent process for eligibility checks

Insurance should always be verified before the patient utilizes any clinical services. Office staff should have a process in place to check eligibility and benefits on the day an appointment is made. It should never be left to billing staff on the back end to deal with eligibility checks. For new patients, office staff need to know:

  • The coinsurance or copay
  • The deductible amount 
  • The benefits cap
  • Where to send the claim
  • Whether the payer requires specialized forms or additional documentation
  • Whether the payer requires authorization. 

For current patients, staff should make a point of checking that the information on file is still current. In fact, healthcare providers should consistently check eligibility throughout the care process. Insurance can expire during the time an appointment is made and when the claim is submitted. Having several checks in place can reduce the likelihood of expired insurance from affecting a patient’s inability to make payments. These checks should include everything from making sure the patients’ details are correct, and entered into the system correctly, to whether they are with an in-network or out-of-network provider.

The benefits of eligibility checks to patients and providers

Verifying eligibility and benefits in advance is important as it allows your practice to estimate the amount of the payment the patient will be responsible for. Health insurance can change rapidly and many patients may experience changes to their insurance or deductible. Patients may not be fully aware of how this affects their coverage. If insurance has lapsed, or the patient is unaware they are not covered for a particular service, practices are at a higher risk of a claim denial.

Checking eligibility first allows your practice to inform patients upfront if there are any out-of-pocket costs. When patients are informed of their estimated costs prior to appointments, they’re far more likely to come to the appointment prepared to pay or make payment plans. By being transparent about coverage, your office staff are actually providing improved customer service to your patients. 

The majority of patients want to pay their bills on time. Not only that, but they also want to be informed about the cost of service before they attend an appointment. With 75% of patients researching the cost of healthcare, it’s safe to say that price is an important factor for patients when they’re choosing a healthcare provider.  

With patients more informed about what they owe, and your own practice more aware of what the patient/insurance split is, there will be fewer claims that get denied due to expired insurance or a lack of benefits.

Increased customer service leads to fewer claim denials and happier patients

The benefit of implementing eligibility checks for reduced denials is obvious, but there are even more positive flow-on effects worth considering. Healthcare is a customer-centric industry. Patients that feel cared for and are happy with their healthcare providers, are not only more likely to return to the same clinic, but visit more frequently for their health-related needs. Providing something as important as price transparency and a seamless eligibility process makes patients feel valued. Healthcare providers should focus on providing great customer service from end-to-end, not just during the appointment. 

The billing and insurance process is one of the most stressful parts of seeking healthcare. Office staff need to understand that these finance-related activities are an important part of the overall patient care experience. Office staff should have the support of the healthcare practice to make the billing and insurance process as streamlined and stress-free as possible. 

Checking insurance eligibility and benefits manually takes a lot of time. Office staff are required to either check the website of the insurance carrier or call a representative directly. Healthcare providers can support their office staff by investing in automated technology that makes the eligibility process streamlined and straightforward. This also frees up staff to have more time to provide high-value customer service duties. 

Implementing automated software to your practice will lift the stress of prior verification of patient coverage. At Health Revenue 360, LLC our experts combine leading technology with over thirty years of combined experience in healthcare revenue management. By verifying patients’ insurance ahead of time, and working to identify and fix billing and coding errors before they become a problem, we help reduce denied claims and strengthen your practice’s bottom line. Our optional software includes communication and engagement tools that are combined to create a 360 degree care approach to interact with your patients, allowing your office staff to focus on providing exceptional customer care to your patients. Reduce denied claims with an automated eligibility process. Contact us to get started today.