Staff may spend a lot of time on the phone verifying coverage and digging for details needed for claims submission. This tedious process must then be repeated regularly to catch any changes. As a result, salaried employees waste hours each week that could be better utilized for patient care.
Even more concerning are the costs associated with submitting claims to payers without first confirming eligibility and benefits. Denied claims increase days in accounts receivable and necessitate appeal efforts that further drain resources. According to industry metrics, providers face denial rates between 5% and 15%, depending on their specialty. Yet many of these could be prevented with automated insurance verification tools.
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The Solution: Automated Eligibility Checks
Automating the insurance eligibility process promises immense savings for today’s busy hospitals, skilled nursing homes, medical practices. This can be also beneficial for companies that provide billing services to the healthcare facilities. Cloud-based solutions leverage advanced technology to research coverage details and track changes 24/7 without staff involvement.
Within seconds, users can check a patient’s active health plan, copays/deductibles, coverage dates and more. Users simply enter the patient’s information and the system does the work behind the scenes.
Most platforms also enable users to set up automated alerts when coverage changes. For instance, providers can be notified if a patient switches insurance or moves to a plan. This real-time tracking ensures billing and clinical staff always have up-to-date information before and during the patient’s stay.
Key Benefits of Automated Insurance Eligibility Verification
Optimizes Workflow, Saving Time and Money
Automating insurance verification alleviates one of the biggest administrative burdens in healthcare.
With an automated insurance verification solution, eligibility checks take less than one minute. Employees can then dedicate their time to more productive revenue cycle management tasks or patient-centered care initiatives. This allows practices to optimize their labor force for maximum efficiency.
Reduces Claim Denials and Improves Cash Flow
Since automated systems provide real-time eligibility data, claims are submitted with the right information the first time. This minimizes denials that might impact reimbursement. Clean claims get paid faster as well, leading to significant cash flow improvements.
More details on handling medical billing denials: https://approvedadmissions.com/handling-medical-billing-denials/.
Eliminates Redundant Insurance Checks Per Patient
How often do providers verify a patient’s coverage information today? Now, consider that most practices repeat this process manually before every appointment.
Such redundancy is eliminated with automated eligibility software. Once entered into the system, it continues to monitor the patient’s information indefinitely. Staff only need to check for updates as alerts warrant rather than re-verifying each time the patient presents for care. Batch checks are also often possible and allow users to upload and check eligibility for multiple patients at once.
Provides Real-Time Updates on Coverage Changes
Insurance details can change frequently for patients. Yet medical practices often don’t notice alterations until after treating the patient and submitting claims. This leads to costly denial surprises.
Automated verification software tracks policies in real-time and alerts users the moment changes take effect. Whether an payer changes service restrictions or the patient switches health plans altogether, practices are immediately notified. They can then update internal practice management systems accordingly.
Integrates Seamlessly Across Platforms
Leading insurance eligibility solutions integrate directly with major practice management and EHR systems. Patient demographics and coverage information automatically synchronize across platforms. This prevents duplicate data entry while ensuring continuity of documentation.
APIs also allow third-party software vendors to embed eligibility checks into their own workflow.
What to Look For in Automated Eligibility Software
When evaluating automated eligibility verification systems, ensure the platform offers the following key features:
- Real-time eligibility checks for hundreds of payers in a single platform
- Regular coverage change alerts
- Effortless integration with practice management/EHR software
- Support for reporting/analytics
- Cloud-based access and mobile optimization
- Hidden coverage detection
The right software becomes an invaluable resource for revenue cycle management and front-end staff alike. While most solutions require investments, the costs are not that significant and pay for themselves exponentially in denied claim savings and workflow efficiencies.
Getting Started with Automated Tools
Transitioning from manual processes to automated eligibility software is easy with today’s turnkey solutions. Some vendors allow users to register for a trial account online in just minutes without IT support. This allows the opportunity to test core features using real patient data before committing.
Most platforms offer different levels of access at varying price points. Smaller practices may only need basic eligibility checks, while large health systems benefit from more advanced insurance discovery detection and analytics. Scalable solutions grow alongside an organization’s specific needs.
Many vendors provide personalized implementation assistance. Dedicated reps help configure eligibility checking to match each facility’s operational workflows. Support teams also train staff so users learn the new tool quickly.
Those looking to reduce denials, maximize reimbursement, and improve efficiency can no longer afford to overlook automated eligibility verification. Such tools deliver measurable returns that more than justify the investment for most healthcare organizations.
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Whether she is researching the latest trends in home decor, life-changing destination getaways, or the best way to maintain your finances, Dewey takes pride in leaving no stone unturned. She is passionate about distilling and delivering high-quality information that you can use to upgrade your life.
