Author: Rajdeep Saha, Revenue Management Lead

Verifying patient eligibility is an important part of the end-to-end revenue cycle management and medical billing process. It enables providers to submit error-free claims. Reduces rejections/denials due to non-eligibility reasons, maximizes collections, and enhances patient satisfaction with less need for claims re-submissions in Revenue Cycle Management services. In this blog, we will discuss the best practice for an Eligibility Verification process

1. Utilize Technology and Automation
In this modern era driven by technology, automation can be a major factor in improving eligibility checks. Healthcare providers can put in place Electronic Health Records (EHRs), and revenue cycle management (RCM) software that integrates directly with the payer networks. These systems can automatically verify the patient’s information to insurance companies which saves time and decreases mistakes.

Automation accelerates the validation process and assists in detecting discrepancies in data or any fields left empty in real time. For instance, with a trigger on a patient’s insurance data that doesn’t match or align with information recorded within their medical history.

2. Train Staff Effectively

This is essential to get staff involved in the eligibility verification process. They must be properly trained and current on the most recent procedures. Keeping the team current by providing ongoing education about policy and procedure changes, for example, with regular training.
It is also important for the employees to inquire from the patient about their new insurance coverage each time they come. 

3. Verify Insurance Coverage before providing services

 Before providing any services it’s important to make sure that a patient’s insurance coverage is verified. This may seem like sense. In the fast-paced healthcare environment, it can sometimes be overlooked. Make sure that the front desk staff is trained to check insurance eligibility when scheduling appointments. During registration. By taking this step, not only it can avoid billing errors. But can also inform patients about any potential, out-of-pocket expenses or the need for pre-authorization. This transparency helps reduce surprises and improves the patient experience.

4. Maintain Patient’s Records

Keeping up-to-date patient records is crucial, for eligibility verification. Encouraging staff to update information, including insurance details during each visit. This practice minimizes the risk of billing errors caused by information. Consider implementing policies and tools to track and follow up on incomplete information. Taking this approach can significantly reduce eligibility-related issues from occurring.

Consider implementing policies and tools to track and follow up on incomplete information. Taking this approach can significantly reduce eligibility-related issues from occurring.

5. Monitor and Audit of Eligibility Verification Processes

Monitoring and conducting frequent audits of the eligibility verification process to ensure continuous improvement. Develop a framework to analyze denials of claiming and what are the reasons. What are the most frequent mistakes or repeated problems that require fixing?

This means you to make adjustments based on how denied claims were handled, and audit the verification process to determine where more accuracy might be made, and what aspects of an automated system can be adjusted for faster turnaround times.

In conclusion, Eligibility Verification is an essential part of Healthcare Revenue Management. Following these tips and practices helps healthcare organizations optimize workflows, decrease billing mistakes, and improve the patient experience. Using technology wisely, educating the workforce correctly on patient identifiers and eligibility verifications prior to providing care, maintaining patient identifying information with proper documentation, and performing regular audits will help healthcare facilities navigate this challenging realm and improve the financial outcome for providers.