Insurance Eligibility

One of the biggest pain points for any medical practice is managing the insurance eligibility process. Delayed or incomplete patient insurance eligibility can lead to significant issues. Patients may come in for visits without paying their upfront responsibilities, such as copays or deductibles, resulting in increasing Accounts Receivables (AR). Your staff simply cannot keep up with front-end operations and complete all the insurance eligibility checks in time!

Failure to complete eligibility checks can lead to uncollected upfront payments for copays or deductibles and cause claim denials. This puts even more stress on the staff, who then must navigate the appeal process or, worse, bill the patient because the service wasn’t covered by their insurance plan. A poll conducted by MGMA revealed that 15% of participants cited eligibility as the root cause of claim denials, and another 5% cited out-of-network issues. Twenty percent of participants had medical claim denials that could have been prevented if the front office had handled all the eligibility details before the patients were seen.

Denials also contribute to a large AR by delaying claim payments by three to six weeks, depending on the time it takes to appeal the denial. Additionally, there is a loss of approximately $100 per claim in staff time to handle each appeal, causing costs to keep adding up!

Wouldn’t it be nice to have someone handle verifying all eligibility details, including copays, deductibles, out-of-network coverage, and whether the service is covered by the patient’s insurance plan? This ensures all information is ready and available when the patient checks in.

At Billed Right, Verifying eligibility is the first step in our Full Revenue Cycle Management