Switching to real-time insurance eligibility verification can boost your revenue. You can use the right software to lessen manual tasks, decrease denials, and save reimbursement. Let's explore the benefits of real-time verification and check out the top solutions available.
What Does Real-time Insurance Eligibility Verification Mean?
Real-time insurance eligibility verification is a way to check if your insurance covers something. Instead of doing it by hand, you use a computer program. You send patient information to the insurance company or a middleman. Then, you quickly get the insurance information, like what it covers, how much you need to pay, and when it's valid. The insurance eligibility verification can be done by in-house staff or healthcare providers get it done by top medical billing companies for accuracy in documents.
Why You Should Check Eligibility Right Away
The Becker Hospital Review tells us that claims get rejected mainly because of eligibility issues. In 2016, hospitals submitted about $3 trillion in claims, and approximately $262 billion, which is 9%, got rejected on the first try.
Hospitals and health systems, on average, lost 3.3% of their revenue from patients because of these rejections. That's around $4.9 million per hospital. Additionally, appealing a denied claim costs about $118 each time.
The number of rejections is going up. From 2016 to 2020, they increased by 9% at the beginning of 2020 and by 11% by the end of that year. It's important to note that 86% of these rejections could have been avoided if the staff had taken the right steps.
Checking eligibility in real-time is now super important to manage rejections. It makes a crucial part of your revenue cycle easier, preventing gaps in your income, rejections, and high expenses that can reduce your profits.
Pros of Real-time Insurance Eligibility Verification
Real-time insurance checks have lots of benefits. It saves revenue and time, and it makes patients happy.
Save revenue by making administrative tasks simpler
You can do less manual work with electronic eligibility checks. Modern tools help you work faster and do fewer repetitive tasks, so you don't have to re-enter or manually check data.
In 2022, the CAQH Index report discovered that electronic checks saved about 14 minutes per task for medical practices. It also saved the medical industry a total of $12.8 billion
Better patient experience
Using electronic verification in real-time makes it easier for patients. It helps them get things done smoothly and without stress. Patients do not have to wait as long for their treatments. They can also plan for the expenses better, which makes it easier for them to get the care they need.
Patients can determine if their insurance covers multiple visits, how much it pays, and what they must pay themselves. They can get cost estimates and make a payment plan. This helps them avoid unexpected medical bills and makes their healthcare experience less frustrating.
Get paid faster and face fewer claim rejections
Dealing with bills, codes, insurance info, and claim rejections is tough in healthcare offices. But there's a way to make it easier. Using real-time verification tech can save you from doing a lot of manual work and ensure your claims are good from the start.
Improve Finances
When you wait to check things, it can be hard on your healthcare clinic revenue. The more time it takes to finish the paperwork, the more money your clinic has to spend. If you have to wait a long time to get paid because of paperwork issues, you must also handle getting revenue from patients much later.
Real-time verification helps clinics get paid faster, reduces the number of problems with paperwork, and saves revenue. This can give clinics more payment and strengthen their financial situation. It also lowers the chances of not getting paid, makes things run smoother and faster, and brings in more reimbursement.
Tips to improve the eligibility verification process
Best practices are like helpful rules for doing things efficiently. They also remind us to do things right and honestly. Here are some of the best methods to follow when checking insurance eligibility in real-time.
Have Clear Communication with the Patients
You need access to the system and patient info to talk to payers. The law says you must have contracts and forms to get access and keep things safe.
Patients must agree to let you use their data. Tell them how you'll use and keep their data safe. If they have questions, tell them how to ask.
Good communication makes patients feel safe and builds trust. It also makes their experience better.
Make sure you get the right information and put it in correctly
Checking if someone qualifies depends on having the right details about them. Gathering data smoothly can make things easier and stop mistakes from happening.
Use automated rules to catch mistakes and stop them. This means forms won't go through if they're missing info. This way, you won't need to type in patient info again. Some tools can also detect identity theft and duplicate info, which stops fraud and data mix-ups.
Another way to improve your overall revenue cycle process is to outsource the medical billing to the professional medical revenue service in Florida. Doing so will help you get the maximum reimbursement as the industry experts are less likely to make medical billing and coding mistakes.
Keep an eye on how well things are going
Modern tools, especially those with machine learning, let you see how you're doing. Machine learning uses this information to get better at what it does. But you can also use this info to find out where things could be faster or more efficient in your work.
For instance, checking how often your claims bring reimbursement can tell you if your verification process is good. Usually, if less than 5% of shares are denied, your verification is doing well.
Conclusion
Determining who can get insurance is essential for healthcare. But if we do it in an effective way, it can lead to big problems like many rejections or may take a long time to get payments. This can hurt your finances and make things unstable. A simple fix for this is using an automated system that checks eligibility in real time. It can make a big difference in your practice.
