5 Proven Ways to Improve Insurance Eligibility Accuracy

A healthy revenue cycle of any healthcare organization is based on insurance eligibility checks. However,  most practices face difficulties, which directly affect the cash flow and patient satisfaction. 

The most common cause of claims denials, rework, and excessively expensive delays is inaccurate or incomplete eligibility checks.

An efficient, streamlined process has stopped being a luxury; it is a key to a sustainable healthcare billing workflow. The right technology and best practices for strategic implementation are important. 

With an emphasis on established methodologies, providers will have a significant opportunity to enhance the accuracy of insurance eligibility verification, increase their clean claim rate, and protect their financial well-being.

1. Implement Real-Time Insurance Checking Technology

The most significant alteration that any practice can implement is the one that would replace manual or batch and next-day checks with automated, real-time insurance verifications.

The manual verification is a time-consuming and error-prone process. Employees can spend hours on the phone or searching payer portals just to have the coverage of the patient shift before the patient receives any service. 

The verification process is automated (integrated solutions) using eligibility check software, which links out hundreds of payers in real time.

How it works:

Instantaneous Checks

When a patient is booked in or checked in, the system will make an instant check with the use of the demographic and insurance details of the patient.

Complete Information

The system not only gives out an active/inactive status, but also provides vital information such as co-pay, deductible outstanding, co-insurance, policy limit, as well as whether a prior authorization is necessary.

Seamless Integration

When combined with the EHR or Practice Management (PM) system, the verified eligibility data uploads automatically, eliminating virtually all errors of manual data entry.

2. Front-Load Validation and Data Collection

The accuracy begins with the collection and the time of collection. The patient must be at the front desk before the verification process is done, and this is a risk to your healthcare billing workflow. 

This can be done by ensuring that verification is a multi-step process, which will start much earlier than the appointment time to maximize the time in which issues can be resolved.

Key Strategies:

Pre-Registration Digital Solutions

Use online patient portals or mobile pre-check-outs, which enable patients to send pictures of their current ID and insurance card. 

This leaves the task of initial data entry to the patient, whereas the system takes them through the process of ensuring the accuracy of key patient data.

The “48-Hour Rule

Implement a policy whereby the eligibility of all patients scheduled should be checked at least 48 working hours before the appointment.

This window gives the RCM team sufficient time to make calls to the patient in order to clarify misleading information or seek missing information, and even negotiate with the patient on self-pay options when they are inactive or not covered by the specific service.

The Second Check

A final check or follow-up check must be done on service day, either manually or using a real-time insurance verification software. This avoids any last-minute termination of coverage that may have taken place during the night.

3. RCM Automation to Eliminate Manual Entry Error 

It is estimated that an incredible amount of claim denials occur because of simple, avoidable mistakes in information entry, including a transposed policy number or a misspelled name, or an incorrect date of birth. 

Automated systems are not simply a validation of eligibility, but rather the focal point of data validation and transfer, which is a driver of medical billing verification accuracy.

RCM Automation Tools Precision Ensured By:

Automated Data Transfer

The seamless connection of the eligibility check program and your billing system will avoid any re-keying of policy numbers, group IDs, or effective dates and will preserve data accuracy in patients.

Standardized Work Queues

Automation can automatically generate a digital work queue of staff, only in the cases where manual approval is necessary, such as secondary insurance checking, prior approval, or a No Response payer. This eliminates staff from wasting time on 80% of clean checks.

Predictive Analytics

Advanced eligibility check software would be able to employ machine learning to detect the trends in previous denials, alerting employees to complex payers or certain services that are most prone to denial, and allowing additional examination of the claim to be made.

Related: 6 Proven Steps to Simplify Insurance Verification and Minimize Claim Rejections

4. Adopt a Strict “Check on Each Visit” Policy

Insurance Coverage is not fixed. Even a change in job, or the new enrollments, and even renewal of annual plans may lead to the lapse or change of benefits to the patient without his complete knowledge or without his immediately informing the provider.

In order to enhance accuracy in eligibility, the practice should consider each visit of a patient, irrespective of his or her level of establishment, as a chance to re-check the insurance information.

Best Practices of Continuous Verification:

Verbal Confirmation and Visual Check

Front desk employees have to physically or digitally check the physical or digital insurance card and ID of the patient during every check-in and compare it with the on-file data. 

The staff members are to ensure that the address, name, and policy numbers are up to date verbally.

Proactive Notification

Advise employees to remind patients of the need to change their insurance information. Send appointment reminder messages to make patients call in the office as soon as possible, in case the coverage has changed since their last visit.

Record All Verifications

All verification information should be documented, including the date of verification, the name of the staff who did the check, the confirmation number of the payer, and the benefits that were confirmed (e.g., Co-pay: $30, Deductible Remaining: $500). 

This careful checking of medical billing is important in submitting appeals on rejected claims and showing good faith.

5. Focus on Pre-admission Patient Financial Communication

Although this is not a technical eligibility measure, clarity with patients on their financial accountability is a key factor in averting denial claims, and healthier the revenue cycle. 

Since the EDCs enable us to communicate with the audience, we can use them to communicate with the audience.

Correct Cost Estimates

The comprehensive benefit details that come back to the real-time insurance verification systems are used to make the practice come up with a Good Faith Estimate (GFE) of the patient, which clearly shows them how much they will have to pay in co-pay and deductible, and the total amount that they are expected to pay.

Point-of-Service Collection

With the correct information on the cost savings, the front desk will be able to ask and collect the co-pay and/or deductible of the patient at the point of service. 

This helps a lot in the minimization of Accounts Receivable days and the cost of collection.

Handling Expectations

When checking the insurance eligibility verification shows that the service is out-of-network or the authorization is needed, the staff can notify the patient on the spot. 

This proactive communication will help avoid the situation when the patient is surprised after the huge bill appears several weeks later, increasing satisfaction and saving the practice-patient relationship.

Vozo Cloud EHR Integrated with Medical Billing

Medical billing is a complex healthcare operation that requires efficiency and precision. Delayed payments, claim denials, and manual errors can slow your revenue cycle and affect cash flow.

With Vozo’s Cloud EHR solution, you get an integrated medical billing system that simplifies your billing process and enhances real-time claim tracking to improve payment turnaround.

How Vozo EHR Transforms Medical Billing:

• Streamline billing workflows and reduce administrative workload.
• Instantly identifies and corrects coding errors before claim submission.
• Speeds up claim verification with automated payer communication.
• Ensures compliance with built-in coding checks and regulatory updates.
• Offers real-time analytics and reporting for better decision-making.
• Minimizes delays by automating claims processing and payments.
• Reduces billing disputes with accurate, transparent invoicing.

Vozo EHR’s seamless integration with medical billing empowers healthcare providers to reduce errors, prevent delays, and optimize revenue cycles, all while focusing on delivering better patient care.