Eligibility and Benefits Verification

Are you a physician or other healthcare entity facing the issue of denied and delayed claims? With your busy schedule and engagement in other core business activities you may be finding it difficult to find some time to investigate and find out what is affecting your ROI. Industry research shows that one in four claims are denied or delayed due to problems concerned with eligibility and benefits verification. This brings to focus an important point. It is vital to verify patients’ insurance eligibility at the point of patient access itself. Healthcare providers need to seriously consider if this is being done systematically. Let us look at some important aspects related to insurance verifications and authorization.

Patient Eligibility Verification – Important Considerations

• Patients’ insurance eligibility and benefits verification should be done prior to the treatment.
• The patient should be informed about his/her payment responsibilities at the time of scheduling an appointment. This helps in avoiding last minute cancellation problems and allows patients enough time to decide on the course of treatment.
• Check with the insurance company whether the payments to the patient are to be made before or after the treatment.

 Claim denials and delays can be reduced to a great extent if advanced information about the plan specific benefits is given to the patients before providing the services. This will ensure that the patients are aware of their healthcare plans, and help avoid patient dissatisfaction and confusion at a later stage. Changes made in the offerings of employee health plans every year is not an unusual thing. Employees may also switch plans on annual basis in order to reduce their expenses. Due to the occurrence of frequent ongoing changes in the health plans, it is very crucial for all those providing healthcare services to have an accurate and upfront eligibility and benefits verification process.

No Dedicated Staff? Hire Insurance Verification Services

The reality is that many healthcare providers may not have dedicated staff to handle insurance eligibility verification in a timely manner. The good news is that healthcare eligibility and benefits verification services are available from leading service providers in the field. It has now become possible for healthcare organizations to electronically validate the patient’s insurance eligibility in real time or by batch. Reputable providers are connected to government as well as private payers and this enables them to provide their clients with detailed information of patient benefits along with important deductible and co-pay information.

Benefits of Hiring Insurance Verification Services



Now, what are the major benefits healthcare providers have by choosing to outsource benefits verification?

• Patient check-in process can be shortened considerably because the eligibility is checked in seconds.
• Easy-to-read benefit statements. You can view patients’ co-pay and deductible information.
• Gain access to major payer connections in the industry
• Experience a definite increase in upfront collections
• Reduce claim denials and delays
• Improvement in cash flow

Percentage of clean claims will increase substantially due to having access to updated eligibility and benefits verification data. The same also helps in eliminating costly reworking while accelerating reimbursement. With a reliable medical billing company as partner, healthcare entities benefit from fully integrated insurance verification services, which will help minimize bad debts and boost patient satisfaction.

• Helps in streamlining workflow

You will find a marked increase in the working efficiency as the eligibility responses are viewed in consistent and concise format. Automated notifications are received at the time when follow-up or edits are required. Healthcare practices can enhance productivity through real-time eligibility and benefits verification, batch processing and time-saving automation. 

With reliable patient eligibility verification services, you will find that your billing system data is cleaner and the cost of billing and collections is lower. You will also experience a decrease in the number of A/R days. Associate with a medical billing company that can offer flexible solutions that ideally integrate with your workflow and enjoy the benefits that come with outsourcing