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How To Overcome The Complexities & Hurdles Of Health Insurance Plans Via Insurance Eligibility Verification Software

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When a person falls sick with an illness that requires long-term care and continuous medication, it is easy to understand the kind of uncertainty they experience. Health conditions, treatment costs, and other family expenses are major concerns during these difficult times.

A benefit verification (BV) from health providers can help ease the patient's mind. It can paint a detailed picture of the costs a person can expect with the prescribed treatment. Here's a little more about the BV. It consists of five components:

  1. The patient's eligibility for coverage.
  2. Coordination of benefits.
  3. Quality review
  4. Additional guidance
  5. Benefits of the prescribed medication plan.

Benefit Verification also translates to a lot of paperwork, coordination between the healthcare providers and insurance workers, and the patient. The entire process can take days to come to completion. Verifying the medication benefits can often be a barrier to starting a patient on medication, with turnaround often measured in days.
And that's not all. There are other hurdles such as:

  • Ever-changing insurance plans and formulas.
  • Coverage adjustments made by payers and health plans on a on-going basis.
  • Confusion regarding the affordability and accessibility of products.

In the healthcare revenue cycle, eligibility verifications and benefit checks are some of the steps you need to take first. Unfortunately, they are also one of the first areas where inefficiencies arise. Healthcare revenue cycles are sometimes plagued by:

  • Inaccurate verifications end in denied claims
  • Accumulating patient balances
  • Scheduling problems
  • Mismatched patient information
  • Unsuccessful patient IDs
  • Longer duration of verification
  • Operational inefficiencies

Evidently these complexities and hurdles need an advanced technology-driven process to weed out the inefficiencies and bring in dynamic changes. This is where Artificial Intelligence (AI) gives a helping hand to vastly improve the way healthcare insurance is delivered and implemented.

Healthcare insurance is a highly complex and intricate system interwoven with policies, laws, and rules. Manual verification and processing would've still been the norm if it weren't for technologies like CoverMe's Insurance Eligibility Verification Software.

However, it is important to understand the role of advanced technology in the healthcare insurance scenario.

AI Effected Positive Transformations In Insurance Eligibility Verification Software

AI is fast becoming omnipresent, and the healthcare and insurance sectors are no exception to its influence. The healthcare revenue cycle is an ideal candidate because AI can revamp all the redundant, inefficient, error-prone, time-consuming processes. As a result, health insurance employees can be more productive and avoid backlogging of claims. This, in turn, will result in increased accuracy, better patient experience, and improved revenue.

Here's how AI will bring about remarkable changes in insurance eligibility:

1. Fewer claim denials

Did you know that the healthcare industry loses around $262 billion annually just because of denied claims? When intelligent automation takes over this highly complicated process, it will lead to:

  • Decreased patient balances
  • Decreased write-offs
  • Accurate and frequent benefit checks

Denials are largely preventable but are only partially recoverable. So the best strategy for managing them is to prevent them in the first place.

2. Better patient experience

The ultimate objective of the healthcare revenue cycle is to deliver a better patient experience when they face unexpected health crises. Negative experiences with the billing department, unforeseen last-minute procedures, and huge medical bills can mar their entire experience. Often, patients can be left with inaccurate details about the cost of treatment and out-of-pocket expenses.

Fortunately, with automated healthcare processes, insurance workers and healthcare providers can accurately explain the benefits and the anticipated costs, leading to higher patient satisfaction.

3. Improved cash flow

There are three contributing factors for cash flow, provided the eligibility is accurate:

  1. Fewer patient balances
  2. Fewer claim denials
  3. Quicker reimbursement

However, some manual processes are time-consuming and complex, such as:

  • Verification of benefits
  • Re-appeal of denied claims
  • Payments

Very often, resubmitted claims are rejected, which prolongs the reimbursement process.
AI can simplify such tasks, thereby redirecting the employee time to other tasks that improve cash flow. As a result, the benefits are accurate, and patients can pay the correct copay at the appointment. Besides, satisfied patients are more likely to pay on time and in full.

4. Reduced employee work time

An AI-powered algorithm can identify trends, discover new rules, and eliminate the need to reprogram the Benefit Verification process manually. This helps expert counselors to focus on connecting with patients and understanding the design of health insurance plans in complex cases.

By using artificial intelligence on eligibility verification, hospitals can also:

  • Improve accuracy without sacrificing employee productivity
  • Reduce downstream errors, such as denials
  • Reassign employees to tasks requiring human interaction

These improvements will ultimately reduce employee burnout and help the hospital.

5. Improved revenue cycle

Automating eligibility and benefit verifications has a tangible Return on Investment. However, piecemeal automation will only result in a sprawl of disjointed vendors and solutions. As a result, there will be more problems.

The trick is to look at the big picture and harness the power of AI by implementing it in all the processes. A full-service, AI-powered healthcare marketplace solution like CoverMe can help revamp and redefine your revenue cycle. Integrating your processes into an intelligent network can provide value today and prepare you for the future.

Revitalize Your Revenue Cycle With CoverMe

Benefit Verification is best handled using a hybrid approach powered by AI and machine-learning technology. It also needs human expertise and intervention to process complex claims and spend more time helping patients.

With CoverMe's automated solutions, healthcare providers and their patients can verify government benefits and enroll in financial assistance programs in real-time. With Artificial Intelligence, you can create a network of systems that connect your processes and provide deeper insight and visibility. Think customizable marketplace, think CoverMe!

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