The Importance of Patient Eligibility Verification to the Revenue Cycle

There are a number of options available to verify patient availability and all of them will more or less impact the revenue stream in a number of ways. One concern is in how well the mode of verifying the patient ahead of time improves the rate of payment from both provider and patient. Another consideration is in the amount of time employees spend in the verification process – for example, manual verification will cost more in employee time than electronic verification.

Patient Eligibility Verification and Its Impact On Patient Payments

There are a few key ways that patient eligibility impacts the amount of time practices will need to wait on full payment for services.

1. Verifying coverage in advance allows the practice to estimate the total patient responsibility for payment. When patients are informed of their estimated total prior to appointments, they’re far more likely to come to the appointment prepared to pay or make payment plans.
2. Patients are sometimes incorrect about their coverage.
   Insurance information can be confusing and is changing rapidly. Many patients aren’t aware that their deductibles have changed or other aspects that will impact the amount of money they need to pay out of pocket is different. A good protocol is to inform patients as soon as possible so that they can budget in the extra costs or work with the practice to create a schedule of payment. Most patients want to pay their bills on time. Patient eligibility verification allows practices to help patients get all of the information they need so that they’re not blindsided by large bills.
3. Verifying eligibility in advance protects practices in cases where insurance has lapsed or policies don’t cover the services.

Options For Patient Eligibility Verification and Its Impact On Employee Time

There are a number of options available to verify patient eligibility. Some practices still rely on manual verification, which means that the employee tasked with verifying insurance coverage will call the carrier to check all of the information provided by the patient. This process can be time consuming, which means that it’s costing the practice in man hours that the employee could be completing other important tasks. Many practices are looking toward switching to electronic patient verification methods or outsourcing.

Options to improve patient eligibility verification:

• Carrier Portals. Insurance carriers each have their own web portals which can be used to verify patient’s coverage information. Each asks for their own specific information, so employees will need to learn a variety of platforms and will need to verify eligibility one patient at a time, rather than many at once.
• Clearinghouse Systems. Practices can enroll in a system which allows them to check eligibility for patients with a wide variety of insurance carriers in one location, learning one platform. This can be a great time saver because employees don’t need to learn multiple systems to complete this one task. There may be instances where an insurance company is not included in the database – those will need to be looked up manually or through the providers web portal.
• Outsourcing. Many practices find that outsourcing is an optimal solution because it takes all of the clerical work in verification and delegates it to an outside agency very experienced in the field. They can often turn around the task with greater efficiency and save the office employees countless hours.

Whatever option a practice chooses as the best for their needs, it’s important for the seamlessness of revenue cycle management that all patient eligibility is verified prior to services.