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Collect More Accurately with Eligibility and Benefits Verification

In this fast paced world, technological advancements have become an inevitable part of our professional lives. And to keep pace with this fast changing world, the medical billing industry has also adopted the relevant changes and become increasingly complex.

Dec 20, 2023 5 min read
Collect More Accurately with Eligibility and Benefits Verification

With complexity, comes a greater need for process refinement. What this complex system now requires, more than ever before, is close attention to validating coverage, benefits, co-payments, and unpaid deductibles. The current status quo has seen proper eligibility verification become very important in the dental industry. Failing to perform proper eligibility verification can lead to unpaid and delayed claims.

Eligibility and benefits verification is the first and most significant step in the medical billing process. Failing to effectively carry out a verification can end up in an unpaid claim by their insurance company. Insurance information keeps changing frequently. Failure to stay ahead of ever-changing regulatory requirements could lead to rejected claims, billing errors, and reimbursement delays, which in turn may affect the overall collection of a practice.

What are the best ways of collecting more accurately?

The most efficient way of collecting is by streamlining the eligibility and benefits verification process. Decrease in delays and denials are also paramount to collecting more accurately. The following methods can be adopted to streamline the process, making it faster and more efficient.

  1. Advance patient insurance verification:
    Verifying the patient’s insurance coverage well in advance allows the practice to have an approximate estimation of the total  patient responsibility for payment. This patient responsibility consists of the portion of the bill that should be paid by the patient themselves, which includes co-payments, unpaid deductibles, and co-insurances. Patients upon being informed of their responsibility prior to appointments, are far more likely to come to the appointment prepared to pay or make payment plans, making the overall collection process easier.

  2. Review, revisit, and reconfirm:
    Once the details of the insurance plan is collected, it is very important to review it carefully to identify errors, spot the gaps and check on the validity of data. This will help reduce delays and denials in the further steps.

  3. Record data for future references:
    The gathered and reviewed data should always be stored and maintained for future use. The data can serve as a ready-to-use reference in the future treatments to avoid miss-spellings and other errors while entering the data.

  4. Use of technology:
    There is no doubts onthe pivotal role of technology in streamlining and easing out a complex process. Technology-based platforms automate your eligibility verification process which, in turn, enhance efficiency and quality helping you collect better.

  5. Identification of pre-authorization needs:
    Pre-authorization is a primary requirement in several of the medical services. These authorizations need to be duly approved, entered in the system, and linked to the correct visits.
    Identifying such cases and obtaining authorization approvals can help ease the billing process, and reduce claim denials.

  6. Updation of Coordination of Benefits:
    Primary, secondary, and tertiary insurance should be thoroughly checked. When patients have multiple insurance plans, it is necessary to remind them to update their coordination of  benefits (COB) with each payer. This allows the elimination of  over-insurance or duplication of benefits.

  7. Benefit limitations:
    It is very important to note down any benefit limits whatsoever, if listed, and check how much of the benefit remains. Some plans may have limitations on the amount payable on each visit or the frequency and time frame in which the services must be delivered.

  8. Maintain data hygiene:
    Patients’ data should be updated  proactively rather than reactively, that is, the document wise requirements from the patients should be anticipated beforehand and collected as per the checklist instead of asking for data as and when required. This helps practices maintain a ready-to-use database and considerably reduce the risk of errors.

  9. Outsource to professionals:
    Professional medical billing services companies come equipped with all the relevant experience and skill sets that are paramount to streamlining the billing procedure and improving efficiency. If a practice faces challenges in regards to being unable to dedicate existing workforce or fall short of expert staff to manage this process, outsourcing the Eligibility Verification and Coverage identification process to professionals could be one of the best ideas.

Conclusion:

In a nutshell, a smooth-sailing eligibility and benefits verification process is very essential to any practice. Working with patients, handling all the relevant paperwork, and verifying patient information with their respective insurance carriers facilitates revenue cycle improvement and maximizes reimbursement. During verification, it is key to keep in mind that the process must be carried out in efforts to reduce claims rejections. Filing for claims rejection is a very time-consuming procedure and can sometimes turn out to be very chaotic. This makes the overall collection process a tedious task which makes it imperative to verify a patient’s insurance plan before the patient gets admitted to any hospital, clinic or medical facility in order to avoid claim rejection. Streamlining the eligibility and benefits verification process would increase efficiency and help the practice collect their receivables more accurately.

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