Patients are taking on more financial responsibility as consumerism rises. The increasing popularity of high-deductible health plans (HDHPs) is a clear indication of this trend. As a result, it is critical to clearly understand the patient’s responsibility for upfront payments and coverage.

This article emphasizes the significance of verifying patient eligibility and benefits.

 

What Is the Difference Between Patient Eligibility and Benefits Verification?

A medical billing services provider must confirm the patient’s coverage for medical services and determine their financial responsibility. Physician practices can confirm the coverage offered by the health plan as well as copayments, deductibles, and co-insurance with the health plan through the patient eligibility and benefits verification process.

Eligibility verification encourages the collection of coverage status and reduces the likelihood of claims being denied. It enables healthcare providers to collect payments from patients in advance, avoiding cash realization delays.

 

Information Required to Check Patient Eligibility and Benefits

One of the most important aspects of front office service is gathering patient information and allowing insurance verifiers to verify benefits.

 

Information Required by Insurance Companies

1) The name of the subscriber

2) The patient’s name

3) Relationship between the patient and the subscriber

4) Date of birth of the patient

5) Gender of the patient

6) Patient identification number

7) Name and number of the group

8) Plan design

9) Date of coverage (policy effective date)

Elements of Insurance Verification

1) Tax Deductibles

2) Co-payments

3) Co-insurers

4) Reimbursable benefits

5) The status of the patient policy

6) Date of application

7) Plan type and coverage information

8) Exclusions from the plan

9.) Make a mailing address claim

 

Healthcare providers must educate their employees about the practice audit and reporting services. Processing efficiently reduces the likelihood of denials and speeds up the cash flow cycle.

 

Processes for Electronic and Manual Eligibility Verification

 

• Most payers have made online eligibility checkers available. You will be able to save time by electronically verifying eligibility prior to the scheduled patient appointment. 
• Obtain accurate information about the patient’s insurance status and comprehend the health plan’s benefits. 
• Determine whether or not you must collect a co-pay at the time of service. 
• Update insurance information 
• Request that patients update their primary care physician information. 
• It is sometimes necessary to contact the payer with questions about prior authorization requirements or to clarify some eligibility and benefits elements.

 

The Significance of Process Documentation

Your practice’s requirements are distinct. A substance abuse treatment center’s eligibility verification requirements are very different from those of a hospital or radiology clinic. As a result, each institution must develop its own eligibility and benefits verification workflows. All members of your team must work together effectively to ensure that all steps are completed efficiently.

 

Competencies in Eligibility and Benefits Verification for Medical Billing Wholesalers

Efficient eligibility and benefits verification processes are critical to the financial health of your organization. The process is also responsible for the majority of claim denials. You must constantly improve and learn from each denial. Medical Billing Wholesalers provides experienced revenue cycle workers to assist your front-office staff with eligibility and benefits verification. Our comprehensive revenue cycle solutions can assist you in lowering costs and increasing efficiency.