Streamline Your Practice with Patient Eligibility Verification

Referencing a patient as eligible for treatment is one of the most delicate processes within a healthcare facility.

Insurance coverage must be confirmed before any medical service is offered. Not only does it assist in lessening

claim denials, but it also contributes to an efficient billing and reimbursement process. The present day

healthcare environment is complicated and the manual verification of eligibility can pose a problem since it is

extremely labor intensive.

Patient-Eligibility-Verification

Problems arise in the form of delays, errors, and loss of finances. The healthcare provider can greatly enhance

their operational efficiency by outsourcing or automating the patient eligibility verification process, greatly alleviating administrative strain while guaranteeing proper claims management.

In this article, we will cover the distance patient eligibility verification is and its importance as well as the ways

Mava Care medical billing company can assist healthcare providers with the task.

What is Patient Eligibility Verification? 

Patient eligibility verification is the task carried out by healthcare practitioners to ascertain whether the

coverage provided by a patient’s insurance company is active, before offering medical help. The checking

of the patient’s insurance details such as coverage, benefits, co-pays, deductibles, and even any limitations

are put under scrutiny. The main aim is determining whether the healthcare provider will receive reimbursement

after offering the services, while at the same time advising patients on the costs they may have to foot out

of their pockets.

The general plan consists of:

Reaching out to the insurance companies: 

It is common for health care practitioners to reach out to insurance companies or utilize specific software

mechanisms to check if the patient’s plan is valid and what services it covers.

Verifying insurance: 

This encompasses all aspects of understanding the patient’s benefits and services sought such as co-pays,

deductibles and even coverage limits.

Verifying eligibility for specific services:

This may include checking the availability of some treatments, procedures, medication and if that will be

covered under the patient’s insurance policy.

Why is Patient Eligibility Verification Important?

Verification of a patient’s eligibility is very important in the practice of health care and it may be for the

following reasons:

1. In most cases a claim is reduced or rejected with a denial rationale.

The greatest advantage that comes with conducting patient eligibility verification is the fact that claim

denials or rejections come down drastically. If there is no verification of the patient’s health cover before

treatment, there is great risk that the health insurers simply refuse to reimburse for the services. Have check

marks for ensured eligibility prior to providing patients with care and other providers are absolved from these

burdensome claim denials.

2. Optimizes Cash Flow and Revenue Cycle Management

Revenues from investments improve when the healthcare providers conduct patient eligibility checks.

They help determine how much the healthcare insurance covers and how much the patient needs to pay,

thus ensuring more accurate billing and a smoother reimbursement process. There are fewer financial

discrepancies and better cash flow at hand.

3. Optimizes Patient Experience

A patient is more inclined to be satisfied with a healthcare provider’s services if there is prior knowledge

of healthcare coverage. Providers who verify eligibility and go through details before treatment ensure the

patient is aware of any deductibles or copays. Reduced confusion and billing disputes leads to improved

patient experience. 

4. Adheres to Healthcare Regulations Standards

With the complexities around patient accounts, it is essential that an eligibility verification is conducted.

Failing to do so can expose providers to compliance risk. Using Medicare or Medicaid reimbursements require

providers to check on patient eligibility before services are offered, aided by the fact that accurate eligibility

verification can create audits and other penalties for the healthcare organizations.

5. Decreases Administrative Load

For many healthcare practices, manually checking eligibility is one of the heaviest lifts considering patient load.

Outsourcing or automating the process allows for healthcare providers to offload the administrative burden on staff to focus on patient care. Such processes would not only enable the business to save cost, but also improve the quality of care offered to patients. 

The Issues of Patient Dummy Diseases Verification

Raising the concern of lacking patient dummy disease eligibility verification will surely raise more questions

than it answers. Addressing the regulations is the primary issue that healthcare organizations work on. It’s one

of the basic and yet hardest steps to get right. 

1. Diversity of Plans

Insurance plans are the most tricky. There are a myriad of challenges which providers face. Coverages,

benefits, and exclusions are just some of the many areas that remain unregulated. Furthermore, the most

difficult task remains for providers – keeping up with the dynamic updates to plans from insurers. 

2. Outdated, Manual Processes

The degree of reliance on manual processes makes the physicians’ task too cumbersome, prone to errors, and

downright inefficient. On some days, eligibility verification turns into a game of telephone, even resulting in

letting the provider miss deadlines or skip tasks entirely. Yes, there is a way to avoid letting a lack of

communication lead to wasted time. However, needing to check every single potential patient causes both providers and the patients to spend more time waiting.

3. Insurance Data Variation

There exist incongruences between the insurance data issued by the patient and those filed to the insurance

company that can cause misunderstandings and lags somewhere. For example, if the patient’s name, address or policy number are not in concordance with the records, the eligibility verification process will surely be slow, hence requiring extra follow ups. 

4. Delays In The Insurance Verification Process

Insurance companies may take time between a few days to respond to the eligibility inquiries which in turn

leads to postponement of treatments and scheduling of patients. For cases which are vital in nature, like

emergency care, it becomes a hindrance to wait around for the confirmation and can aggravate the situation

for patients as well as the healthcare workers. 

Ways To Enhance Patient Eligibility Verification

To overcome the hurdles and make the process patient friendly, one can adopt the following approaches for

patient eligibility verification:

1. Automated Patient Eligibility Verification Tools

Self patient verification eligibility systems can automate the process and save valuable time and effort.

Various programs available for this purpose can help medical staff verify eligibility of patients efficiently

and electronically and receive updates from the insurance providers in seconds. Verification is done by pulling

data from the insurance databases which in turn provide results in seconds, hence minimizing human

intervention and reducing chances of mistakes and lags.

2. Eligibility verification outsourcing

The vast majority of healthcare providers prefer to outsource this task to service providers. This gives

healthcare organizations the opportunity to transfer the process's responsibility to a third party, which allows

them to concentrate more on their areas of specialty. Additionally, the verification process is significantly

more efficient. Cash flow for the organization is also improved as outsourcing this function helps to eliminate

delays which always occur with the in-house approach.

3. Improved Communication with Insurance Providers

Healthcare organizations can deal with verification problems more successfully, by having well-structured

communication systems with insurers. This can be done by talking to the insurance companies directly or

through specific online portals which help in establishing the relationships and fastens the response to eligibility

verification queries.

4. Self-service by Patients

Not relying on providers for the verification, but allowing patients to do it themselves from the comfort

of their homes before they make an appointment, can reduce or eliminate delays and confusion. A growing

number of healthcare providers have set up patient portals so that patients can provide their insurance details

for verification before the appointment. Eligibility can be verified before the patient arrives at the clinic and

this enhances the efficiency of the check-in process.

The Mava care Medical Billing company’s Role in the Patient Eligibility Verification

We at Mava care Medical Billing company know the extent of problems faced by practitioners regarding

patient eligibility verification issues. We provide specialized services that aid in streamlining the verification

process, such as, enhancing cover acceptance accuracy and minimizing administrative loads.

Some of Our Services Are:

Last minute eligibility verification: 

We adopt an aggressive approach to verifying patient eligibility by employing automated systems.

Follow-ups with insurers:

We liaise with insurance companies to clear their discrepancies and remove any delays they might have.

Notification of patients: 

We notify patients of the specifics of their coverage, including co-pays, any deductibles, and out-of-pocket

expenses that might be incurred so that they are fully prepared when they come in.

Outsourcing options: 

We offer full outsourcing of the eligibility verification for those practices with fewer resources,

enabling you to concentrate on patient care.

With Mava care Medical Billing company’s assistance, providers of healthcare services can successfully

shift the burden of managing eligibility verification to someone who would do it accurately, productively

and in accordance with the set regulations of the business. We help enhance your practice’s revenue cycle

management by decreasing claim denials and increasing patient contentment and faster payments.

Conclusion

It is a well-established fact that patient eligibility verification plays a pivotal role in the revenue cycle of the

healthcare system, and it can have a direct effect on the provider’s cash flow. Healthcare systems are able to

improve the cash flow, reduce claim denials, and elevate patient satisfaction indices by ascertaining coverage

prior to the delivery of treatment. 

While this process may be intricate and tedious, the implementation of automated systems or offshoring the work can alleviate these challenges, simultaneously increasing accuracy. Using an Mava Care Medical Billing Company enables providers to have a trustworthy source that is integrated efficiently into the practice and assures the patient eligibility verification process is maintained within set guidelines, resulting in improvements to the revenue cycle and hence, financial performance to the practice.