A consistent and vigorous revenue stream is the veritable lifeblood of any medical practice. Maximizing a revenue stream’s potential is especially important for small medical practices, ABA therapists, and solo practitioners.
Fortunately, 21st Century communication technology offers medical practices of all scales and disciplines a spectrum of innovative solutions to streamline as well as maximize revenue streams. One of the places where it pays the most dividends is the ability to receive real-time eligibility verification.
There are even a few ways to obtain real-time eligibility verification. Though the most popular method is via a web portal that all stakeholders in the healthcare sector have access to. It is very quick to log on to, for updates and superior access to information.
The overarching goal with the web portal and other electronic methods is to obtain errorless, cost-effective eligibility verification in real-time, to ensure that patients can receive the maximum level of care they are entitled to. As well as reducing the risk of medical billing errors. The convenience of this system even has many medical practices verifying eligibility as part of the patient intake or scheduling process.
What Is Real-time Eligibility Verification?
Real-time eligibility verification gives medical practitioners and insurance providers instant access to information needed to submit and pay a claim. This includes key pieces of information like the coverage dates of the patient’s policy, levels of coverage, as well as access to important details on the insurance coverage status such as co-pay obligations and the current deductible status.
The Benefits Of Real-Time Eligibility Verification
With most patients, real-time eligibility verification can be done even before a patient visits the facility as part of the intake or scheduling process. This is a great way to help reduce the risks of rejected or denied claims that can come when a medical practice just blindly accepts the information provided by the patient alone.
The Process Of Real-time Eligibility Verification
Throughout the healthcare system, different stakeholders such as healthcare providers, payers, and pharmacists are trying to synchronize patient information to reduce problems caused by fragmented care, as well as inaccurate medical billing practices.
Cutting-edge patient eligibility verification software helps providers from all these different disciplines and points of care to customize the process to suit their various needs. This includes things like burgeoning AI and machine learning solutions that aid in collating payer-remit data, as well as identifying claim denial risks before they occur. These systems can even provide alerts if corrective action is not initiated within a specified window of time.
The end result is fewer claim rejections and claim denials as well as higher patient satisfaction levels.
Some of the key data available to providers via this system include:
- Any applicable Medicare coverage
- Coverage dates
- Dates of previous services
- Key patient demographic information
- Patient responsibilities including co-pay, co-insurance, and current deductible amounts
- Total and remaining deductible amounts
- Past and present referrals
- The claims mailing address
- The status of the patient’s lifetime maximum
- Address for claims submission
- In-network or out-of-network status
- Durable medical equipment coverage
Real-time eligibility verification also helps manage the nuts and bolts details of a patient’s information. These things might seem minor at first, but even simple data entry mistakes can lead to delays in the claim process. This includes things like:
- The accurate spelling of the patient’s name
- The patient’s date of birth
- The patient’s Address
- Social security number
- Insurance carrier name
- Their ID number
- Their Group number
- Key coverage details
- Play details
- Patient policy status and effective date
- Any current plan exclusions
- Payable benefits under the current plan
Comparing Real-time Verification To Traditional Eligibility Verification
As an important second phase in the revenue cycle management process, eligibility verification plays a key role in receiving timely payment for services rendered. With traditional eligibility verification methods, there was no effective verification procedure, which led to a wide range of costly errors made during the equally important “Claim Submission” phase of the revenue cycle.
With traditional eligibility verification practices, there was typically a delay of a day or more, which can affect the revenue stream and also increase the risk of the patient experiencing fragmented care. It also increases the risk of a patient receiving a treatment that is not fully covered under their current plan.
With real-time verification, the single web portal essentially streamlines communication with payers while also giving providers rapid eligibility responses. This makes it much easier for the medical provider to verify the insurance coverage in a matter of minutes instead of days.
The Eligibility outputs generated by real-time verification are immediate, as well as designed to be easy to read. These outputs also include important information about things like co-pay and a patient’s remaining deductible for that coverage cycle. This makes it easy for the medical provider to decide if a patient is eligible and what their insurance coverage details are even before administering care.
Real-Time Eligibility Verification Helps Reduce Denied Claims
Research performed by the American Association of Professional Coders found the top four reasons for denied claims are:
- Partial or incorrect patient information
- Expired insurance coverage
- The performed services were not included in the patient’s coverage plan
- Prior authorization was required under the patient’s plan
Thankfully, the rapid response provided by real-time insurance eligibility verification software helps to prevent these problems like simultaneously making it easy to catch errors or correct the information.
Other Benefits Of Real-Time Eligibility Verification
Real-time eligibility verification also has other benefits that go beyond catching the errors and incorrect assumptions that lead to so many denied claims. It can also help with the following things:
Increased Claim Pay-Outs
With more accurate information that starts during the intake and scheduling process, you are less likely to see delays from payers.
Enhanced Cash Flow
Real-time eligibility verification also helps to streamline a small practice’s revenue stream, while also making it more consistent and efficient.
Being able to verify a patient’s information before they even step foot through the door means that all the information is correct and consistent throughout the treatment process and the revenue stream.
Being more informed on their coverage and treatment options gives a patient a sense of confidence and ultimately translates into the patient receiving more effective care, with a minimum out-of-pocket price passed on to them. This helps maximize patient satisfaction levels in the short as well as long term.