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Gain Insights About Real-Time Patient Eligibility Verification

Published on December 20, 2021 
by CoverMe Team

For a healthcare organization to work effectively, obtaining accurate patient demographic and insurance information is a vital first step! Failure to do so can lead to denials and delayed payments. In the past, medical providers relied on numerous phone calls and websites to verify patient and insurance information. And this was a very inefficient process. A much better solution for medical providers is to employ a robust real time eligibility verification tool.

With real-time patient eligibility tools, healthcare providers gain multiple benefits such as:

  • Access to prompt and precise determination of their patient's eligibility for coverage, payment obligations, and benefits.
  • Submit clean claims and reduce claim resubmissions and delays.
  • Reduce eligibility or demographic-related denials and rejections.
  • Increase upfront collections, thereby improving billing process and patient satisfaction.

Analyzing the Impact of Patient Eligibility Verification

By verifying patient coverage in advance, independent medical practitioners, hospitals, and other healthcare providers can easily ascertain whether the patient will be able to pay the bills for their treatments on time.

Further, there are instances where patients may have incorrect knowledge about their coverage options. They may not be aware of their deductibles or might conceal the truth about their deductibles. Hence, verifying eligibility in advance is beneficial for the healthcare providers and the patients. With a reliable real time patient eligibility solution, patients and providers obtain the relevant information before the treatment commences. Thus, there will not be any sudden surprises about lapsed insurance and policies that do not cover a particular treatment.

Working Principle of Real-Time Eligibility Verification

There are many stakeholders in a healthcare system. Pharmacists, healthcare providers, and insurance providers or payers rely on accurate patient information to avoid fragmentation of care and inaccurate medical billing procedures. A reliable patient eligibility verification system like CoverMe helps providers by customizing an accurate and effective process to meet their needs. This includes leveraging AI and ML solutions to quickly and efficiently validate patient demographic and insurance data to help mitigate claims denials.

The RTE verification process will help manage the intricate details of each patient's information. Simple errors can delay the entire claims process and impact collections. Using an RTE verification process can help eliminate errors, including:

  • Spelling mistakes in the patient's name
  • Errors in the social security number
  • Incorrect key coverage details
  • Mistakes in patient's date of birth or address
  • Errors in insurance carrier ID number and name
  • Missing to include current plan exclusions
  • Patient policy status and effective date errors

Real-Time Verification Vs. Traditional Eligibility Verification

Before the age of RTE or electronic health records, patients used to provide their personal information either before or during a medical visit. The front desk staff will note it down and contact the insurance provider to check the details. But, this process was very time-consuming and used to eat into the man-hours employees could have utilized productively to take care of other tasks. Let us now take a look at some of the key points that differentiate RTE from traditional eligibility verification:

Traditional Eligibility Verification:

  • Lack of effective verification procedures. This can cause costly errors during the claim submission phase of the revenue cycle.
  • Claim processing gets delayed, which in turn affects the processing of claims. It can also increase the risks of patients opting for a treatment that may not be covered under their current coverage plan.

Real-Time Eligibility Verification:

With real-time eligibility verification, the eligibility outputs are generated quickly without any delays or hassles. This helps the medical provider to be adequately informed of the patient's eligibility for coverage and their coverage details before proceeding with the treatment plan.

Further, denied claims will be considerably reduced as RTE helps avoid errors such as:

  • Incorrect or partial information
  • Non-covered treatments
  • Expired insurance coverage
  • Missing prior authorization

Best Practices to Improve the Efficiency of Patient Eligibility Verification

  • Collect, analyze, and utilize available data about patients and their insurance plans from available data sources.
  • Review all the obtained data in detail to avoid the chances of missing data or using old or incorrect data.
  • Carry out regular follow-ups to identify and fill in the missing pieces of information.
  • Verify the information provided by the patients with the payers to avoid chances of discrepancies.
  • Obtain pre-authorization approvals in advance to enhance the patient experience and avoid claim denials.
  • Use real-time data analysis tools to gain immediate access to all payers
  • Confirm insurance coverage and discuss options with patients.

An Accurate and Automated Eligibility Solution Is the Need of the Hour

As eligibility challenges grow more complex, providers can no longer rely on a simple "yes or no" check. An automated and accurate eligibility solution is now required. CoverMe offers comprehensive eligibility verification to help healthcare providers get accurate and reliable information in real-time. CoverMe helps avoid the errors in eligibility checks caused due to improper verification processes and will act as a lynchpin of the healthcare revenue cycle. CoverMe is driven by the mission to make the patient eligibility process simple, quick, and effective! To know more, get in touch with the CoverMe team.

Written by CoverMe Team
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