How to maximize eligibility verification

As healthcare provider profit margins continue to be threatened by unprecedented industry changes, it’s more important than ever to focus on the details of the revenue cycle—especially eligibility verification.

Today’s continually changing and increasingly complex healthcare environment requires close attention to validating coverage, benefits, co-payments and deductibles. Failure to prioritize this seemingly small step in the patient access process has huge implications for providers and patients alike:

  • Inadequate verification of eligibility and plan-specific benefits puts the healthcare organizations at risk for claim rejections, denials, and bad debt. Ineligible patient insurance coverage is the second most common cause of all claim rejections and denials by payers¹.
  • Not understanding coverage and benefit specifics leaves patients financially exposed, fearful and frustrated. In fact, 95% of all patients want a full understanding of coverage and costs involved in a medical procedure.

As benefits become more granular and coverage more unpredictable, providers are recognizing the need to take measures—including implementing workflow automation and data optimization—to help them tackle the increasingly intricate eligibility process.

By approaching eligibility verification right from the start, and managing it closely on a continuous basis, providers have the opportunity to reduce financial risk, increase revenue, improve patient relationships, and streamline staff workflow.

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