How much time do you spend each week verifying patient eligibility? Do you spend hours calling insurers to confirm policy information and coverage? Do you wait for responses, fill out forms and generally spin your wheels when it comes to eligibility verification? If you’re nodding along as you read this, you’re not alone.
Eligibility verification is a crucial aspect to running a business whether you work for a billing company or physician’s practice. With an additional 30 million uninsured Americans now receiving healthcare coverage under the Affordable Care Act, verifying procedure benefits, prior authorizations, referral requirements if applicable, and covered and non-covered conditions for certain procedures is imperative. Without such verification, you will likely experience high levels of insurance denials and lost revenue. Eliminate the possibility of uncollectible revenue from patients with invalid or insufficient insurance benefits – let the experts here help you!
We’ve been around the block and have helped numerous practices and companies get on the right track with eligibility.
In fact, we frequently hear of many misconceptions when it comes to eligibility checking. While these may seem harmless, or like “no-brainers,” these misconceptions can actually hurt your workflow and revenue. For example:
Misconception #1: Clearinghouses have all the answers.
Unfortunately, this just isn’t true. Clearinghouses certainly have an enormous amount of information and technical capabilities to gather some eligibility information, but it isn’t guaranteed to be accurate or thorough enough. To get speedy and accurate verification, you need live representation and phone calls from knowledgeable professionals (like us!).
Misconception #2: The EHR has all the information I need.
Anytime an EHR allows you to have Level 1 verification, it’s very basic. Too basic, in fact. You will likely not have access to specific diagnostic codes and procedures. This obviously creates long-term problems for patient data records and insurance coverage.
We explore more on the topic of eligibility below.
Enjoy this month’s ClinicSpectrum newsletter. As always, we appreciate your feedback. Please reach out if you have comments or suggestions.