Skipping Eligibility Verification is Number One Cause for Claim Denials

June 23, 2021

About 45-85% of denials most practices observe are related to Insurance Eligibility Verification! Does your practice relate to this fact?

Reducing the eligibility and demographic-bound denials and rejections is important, as overlooking this factor can cause delays in the revenue cycle management and ultimately result in revenue loss.

Lack of consistent and reliable information technology (IT) systems has made it difficult for practices to determine a patient's eligibility. This has led to missed revenue and frustrated patients.

Practices can address these challenges by automating eligibility verification and ensuring that software is capable of integrating with the practice's RCM process. In addition, they should ensure that the IT system can automate the eligibility verification process to serve as a single point of contact for the patient.

A simple task, diligently handled can lower the headache for the practice.  Most software provides a feature that pre-checks eligibility based on the scheduled patient list for the day. This pre-check generally covers most patients, and any patients who were not checked in this process can be verified manually.  

Eligibility verification is especially important during the beginning of the year since a significant number of patients switch carriers and plans.

There are myriad variations in benefits as insurance carriers proliferate with various coverage options even for a seemingly similar plan.

The eligibility verification process must check specific coverage for the type of visit the patient is scheduled for as well as co-payment and pre-authorization requirements.  Other factors that may be relevant to your practice include eligibility for the specific provider location, procedure code, and numerical limitations for the procedure in a given period.

If eligibility verification is done right, along with patient balance collection, your practice can progress towards a 100% collection rate.

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