Did you know that around 24% of medical claims are rejected due to eligibility and registration issues? These range from incorrect demographic details to patient not qualifying for health benefits on the date of service.
To address these concerns, it is crucial to seek accurate eligibility and benefits verification services. Eligibility verification process in medical billing involves confirming a patient’s insurance benefits and coverage before rendering any medical services. This process is important to make sure that a provider gets reimbursed for the delivered services, and patients are aware of their financial responsibilities.
That being said, here is everything you need to know about the significance of precise eligibility and benefits verification in reducing claim rejections.
The Impact of Claim Denials
Here are the main ways in which claim rejections affect healthcare providers:
Financial Consequences
Claim rejections lead to not only revenue loss but also increased administrative costs. Per the Journal of AHIMA, hospitals incur a loss of $5 million on average annually due to claim denials. This amounts to 5% of their net patient revenue. On the other hand, during denial and appeal management, it costs an independent medical practice $25 and a hospital $181 to rework on a denied claim. Moreover, as many as 60% of rejected claims are never reworked.
Operational Challenges
Claim denials also lead to operational challenges like payment delays and increased workload through the provider’s need for RCM denial management.
How Does Eligibility and Benefits Verification Work?
Benefit verification in medical billing is conducted to ensure that patients and healthcare providers are on the same page about their financial responsibilities and insurance coverage to reduce the chances of denials.
Medical billers perform the following steps when offering eligibility and benefits verification services:
- Confirm the patient’s eligibility for health insurance benefits
- Determine eligibility verification requirements for prior authorization and referrals
- Identify the primary and secondary payers
- Evaluate out-of-network benefits
- Verify the patients’ coverage, deductibles, co-insurance, and co-payments
- Patient follow-up to seek any incorrect or missing information
Benefits of Eligibility and Benefits Verification
According to a study, 63% of initially rejected claims could be recovered after resubmission. Accurate eligibility and benefits verification services can increase the chances of it. Here are the benefits of performing this process:
Ensures Accurate Insurance Information
Eligibility and benefits verification process in medical billing proves that a patient’s insurance details are updated and correct. This minimizes the chances of claim denials. Pre-screening coverage details keep staff better-informed and ready to resolve any disputes in the course of claim submission.
Enhances Patient Satisfaction
As a result of claim denials, patients have to bear unfavored charges which lead to their dissatisfaction. This approach removes any confusion since patients already know their financial expectations. It helps strengthen the relationship with the patients and establish trust with them. This is vital for providing care since patients will not have unexpected costs to avail their treatment.
Identifies Insurance Coverage and Benefits
Benefit verification in medical billing also helps identify the patient’s enrolment status. It shows the extent to which a patient is covered, i.e., the procedures or services are covered. This information is crucial to determine which expenses the insurance would bear and which costs the patient should meet. It can help patients make the right decisions related to their treatment and avoid any surprises regarding the bills. Being aware of the coverage in advance helps handle claims better as they are processed correctly due to the patients’ eligibility status.
Improves the Financial Health of Medical Practices
Error-free eligibility and benefits verification services also enhance a healthcare practice’s financial health by lowering claim denials, minimizing administrative costs, and ensuring timely payments. By verifying patient insurance details upfront, you can avoid mistakes that result in denials to streamline billing and improve cash flow. Moreover, it allows for upfront collections and helps patients have a clear idea about their financial responsibilities, resulting in higher patient trust and satisfaction. Thus, it overall ensures better reimbursements and lower operational costs.
Lowers the Administrative Burden and Rework
Inaccurate claims can require too much unnecessary work. When a claim is rejected due to incorrect details, billers need to redo the eligibility verification process. Repeating it increases waiting period which adversely affects the time when the payment is realized. Correct eligibility checks help reduce resubmission work. This leaves more time for the administrative staff to perform important roles. Thus, both the billing process is improved, and operations are streamlined. On the other hand, proper eligibility verification helps ensure that claims are correctly filed the very first time.
To conclude, accurate eligibility and benefits verification can help healthcare providers reduce denials, improve reimbursements and lower operational burden. Training the in-house team in carrying out eligibility verification can be resource-intensive. Therefore, it is better to outsource eligibility verification process from a reliable medical billing company like RCM Workshop which has a dedicated team of experts trained and skilled in insurance verification. Also, regular verification, i.e., double-checking eligibility before every visit helps update any changes in coverage, preventing problems from emerging later. Other best practices include communicating clearly with patients, gathering comprehensive patient information, establishing a verification workflow, and partnering with expert denial management specialists. Implement these practices to streamline your billing and secure your revenue!
