What is Insurance Eligibility Verification?
Insurance Eligibility Verification is the process of obtaining the insurance status of a patient in order to minimize errors in medical claims processing information to avoid delays in revenue cycle management. It also provides information beforehand about the patient’s insurance coverage, co-pays and deductibles as well as services that are not covered for a particular specialty.
Importance of Insurance Eligibility Verification:
Today, the patients suffer a lot due to the major drawbacks in the eligibility and benefit verifications processes followed by many healthcare providers. The healthcare providers lose a lot of time and financial capital in delays due to time taken for medical claims processing and rejections. Therefore, in order to streamline the access of patients to the right physician, it is extremely important to get the insurance eligibility verification done without any delay. In addition to this, the biggest advantage to both the patients as well as the providers is that they are both in the know about what is covered and what is not to determine the best plan of care. The verification can be done in two ways – via a call to the Insurance Company (payer) or via websites (payer or EDI). With the help of Insurance Eligibility Verification, revenue cycle management can be improved up to four times by reducing the number of rejected medical claims and improving the flow of cash. Online verification saves even more time and facilitates collection of estimated patient payments in advance at the time of hospital visit saving patients from ‘Balance due’ statements 3 to 6 months later. Last but not the least, the efficiency and productivity of staff members at healthcare entities can also be improved by an effective insurance eligibility verification process.
How Insurance Eligibility Verification works?
There are two types of Eligibility verifications. The first one is a basic verification that gets basic coverage details of the patient in addition to the co-pay and deductible details. The second is much more in-depth and involves the gathering of ‘code specific’ eligibility with annual max or lifetime max limits. The second type of verification is very useful for some of the ‘super specialties’ like Cardiology, Nephrology, Urology, Chiropractice, Gastroenterology, General Surgery, Physical Therapy etc. The major advantage is in the revenue cycle management and collections, where a medical claims processing rejection can be disputed with the payer based on the eligibility information that was obtained before the patient’s visit.
Impact on Collections:
As explained earlier, the biggest impact of a thorough Eligibility Verification is on the revenue cycle management. Many Providers ignore Eligibility as a waste of money and effort. But, if they adopt this process, a lot of time can be saved during the revenue cycle management resulting in faster medical claims processing that would deliver substantially better Collections than their current levels.
About the Author:
Tanya Gill is the Public Relations Manager for ecare India based in Chennai, India. She has wide knowledge and experience in the medical industry. ecare India is a leading medical billing company offering end-end medical billing, charge entry, medical coding outsourcing, healthcare outsourcing, physicians billing services and is backed by extensive domain expertise, latest technology and dynamic compliance norms. ecare is HIPAA compliant and is the first Indian medical billing company to get ISO 27001: 2005 certified for information security management. ecare is also ISO 9001:2008 certified for quality management. By providing outsourced medical billing services, ecare makes it feasible.
Insurance Eligibility Verification - A Boon For Easier Set