Thursday, July 13 | EHR Solutions and Operations, Revenue Cycle/Billing, Thought Leadership

Growing and Harvesting Results with Automated Eligibility Verification 

By Matt Zabolotny, VP/GM, Revenue Cycle Management

You're heading to the Saturday farmers’ market where you can’t wait to purchase your favorite fruits and vegetables. Vendors only accept cash for purchases so you’ll need to stop by the bank first. Your bank isn’t nearby so you go to the closest ATM on the way to the market.  You put your card in the ATM and in a matter of moments, you have cash in hand from a bank that you don’t typically do business with. The integrated financial network allows you to withdraw money from any bank across the world with ease.

Imagine if this easy access to your money wasn’t always the case. Imagine that for every transaction you made at a bank that wasn’t yours, it took hours to verify your account balance in order to make a withdraw. Then, the bank would call your bank, and maybe even you in order to verify your account and balance before making the transition. A lot of time wasted for a simple action to happen. This is similar to how many healthcare providers are currently operating with insurance coverage verification as part of their revenue cycle management processes.

Proper revenue cycle management begins with accurate and timely insurance coverage verification.  Improper eligibility verification results in the majority of claim denials that providers face. Coverage information, Medicare regulations and insurance policies are constantly changing and as a result, providers must verify eligibility frequently across a spectrum of payers. The need for verification is not the problem, but rather how it’s being done, which is not at all efficient.

Traditionally, a front office associate would use a web-based portal to check an individual’s eligibility to receive services at intake and, if time allowed, again during the course of treatment. If an individual has their insurance card, the associate makes copies for the paper chart and may call the insurance company to verify benefits, both of which take time. Add even more time to that when the billers need to research eligibility denials and coverage issues, and gather data while communicating back and forth between an individual and the insurance company. The large amount of time used compounded with a large amount of individuals receiving services uses an unfathomable amount of time that could be used for patient care.

Time, once it’s used, is an asset that’s impossible to get back.

Networking with national systems to maximize efficient and accurate eligibility verification is essential to maximize reimbursement opportunities. Providers who utilize an automated eligibility verification system are able to alleviate pressure on their own resources, staff and patients by having access to real-time data which can expedite the verification process and decrease claim submission errors. By confirming accurate coverage information prior to care delivery, providers can reduce their denied claims while improving their financial collections.

In the future, determining insurance eligibility will continue to grow in complexity. Private and government insurers will remain under constant pressure to reduce costs, creating a heavy burden on providers. By implementing tools to manage consumer eligibility today, providers will ensure ongoing financial stability – like knowing that you can rely on any local neighborhood ATM when you need access to your cash on the go.

 

 

Meet the Author

Matt Zabolotny · VP/GM, Revenue Cycle Management

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