Accuracy and efficiency are paramount in the intricate healthcare landscape, where patient care and administrative tasks intersect. One crucial aspect that embodies this balance is eligibility checking in medical billing. This process, often overlooked, holds the key to preventing claim denials, reducing administrative burdens, and enhancing both patient satisfaction and financial outcomes for healthcare providers.
What is eligibility checking?
Eligibility checking is the process of checking a patient’s healthcare insurance benefits and coverage status such as deductibles, co-pays, limitations, and in-network providers before rendering healthcare services. By conducting this verification before treatment, healthcare providers can ensure that patients are aware of their financial responsibilities and avoid unexpected billing surprises.
Why is eligibility checking important?
Reduced Claim Denials:
Claim denials can be a significant drain on resources and revenue. Eligibility checking plays a pivotal role in reducing denials by identifying issues with insurance coverage before services are provided. This proactive approach minimizes the chances of claims being rejected due to coverage issues.
Enhanced Patient Experience:
Patients appreciate transparency and clear communication when it comes to their healthcare costs. By providing accurate estimates of out-of-pocket expenses before treatment, healthcare providers empower patients to make informed decisions about their care.
Streamlined Administrative Processes:
Traditional insurance verification often involves a cumbersome exchange of paperwork and communications with insurance providers after treatment. Real-time eligibility checking streamlines administrative processes, freeing up staff to focus on patient care and reducing the need for back-and-forth communication.
Optimized Revenue Cycle:
Eligibility checking aligns with the broader goal of optimizing the revenue cycle. By addressing potential issues at the outset, healthcare providers accelerate the claims process, leading to faster revenue collection.
Accuracy in Claims Processing:
Real-time eligibility checking ensures that the insurance information on file is accurate and up-to-date. This accuracy translates into claims that are correctly processed the first time, saving time and resources for all parties involved.
Empowerment for Preventive Care:
Patients with accurate information about their insurance coverage are more likely to prioritize preventive care services. Eligibility checking encourages patients to take proactive steps for their health.
Key Considerations and Implementation Challenges
While the benefits of eligibility checking are clear, successful implementation requires careful consideration of several factors:
Technology Integration:
The eligibility checking process should seamlessly integrate with the electronic health record (EHR) and billing systems used by the healthcare facility.
Data Security:
Handling patient information and insurance details requires strict adherence to data security standards and HIPAA compliance.
Patient Education:
Patients need to be informed about the eligibility check process and its benefits. Clear communication ensures cooperation and reduces misunderstandings.
Provider Network Knowledge:
The system needs to have access to up-to-date information about insurance providers’ networks to accurately verify coverage
At Adnare, we provide health insurance eligibility verification services to assist you to:
- Minimize rejections and denials
- Improve bad debt write-off scores
- Reduce coverage errors
- Reduce Patient AR by providing accurate information of Copay, co-insurance and deductible
Our process includes the following steps:
- Information about a patient’s demographics is collected from referral sources, such as hospitals and clinics, or directly from the patient
- Verification of patient information with demographics and indicated carrier
- Verification of patients’ primary, secondary and tertiary insurances
- Our process after getting information from a referral resource includes the following areas:
- Eligibility status
- Duration of the active plan
- Payable amount
- Co-Pay
- Deductible
- Co-insurance
- Indicating any special coverages i.e. dental, vision, podiatry, etc
- After getting all the needed information, patients’ accounts are updated with great efficiency and accuracy
- Communication with patients and making sure they are aware of their accounts
- Our specialists also communicate with insurance companies for missing information and other details so the billing process runs smoothly.
Our verification specialists work with payers, front desk office staff, and patients to verify eligibility and acquire authorizations for treatments or procedures to be delivered. They are well-versed in all aspects of health insurance, healthcare terminologies, and medical/surgical practices.
Why choose Adnare?
- Our team is highly experienced in handling EHR systems as well as external portals, including insurance portals and clearing houses.
- We are inclined to stay ahead of time and our benefit verification team gathers the required information before the appointment time
- Our team has the ability to identify any loopholes in the patient information, starting from demographics to insurance benefits and with effective knowledge and highly curated problem solving skills, they can find solutions really quickly
- We provide dedicated resources to work directly with the front desk staff. They obtain real-time eligibility while patients are sitting in hospitals/ clinics/ offices and waiting for their turn of appointment
- We realize that no matter how diligently our team works, there is always room for a little hiccup that can affect the process. That is the reason we have a highly active QA team that ensures 99% accuracy by implementing advanced QA techniques and processes
