Proactive Revenue Management Requires Eligibility Verification at Every Visit

Managing your revenue cycle is a daily need. Typically, a practice’s primary focus is on claim submission and denial management. While I agree that these two aspects are extrememly important, there is another aspect to revenue cycle management (RCM) that you may be overlooking, and it’s rapidly gaining in significance: eligibility verification.

Eligibility verification is one of those things many practices used to do once a year, when patients presenting for appointments would be asked to “update their files” by validating or filling out new insurance data forms. More recently, practices have adopted the procedure of periodically asking, “Is your insurance information still the same?”

Unfortunately, neither of these options is truly viable in today’s environment. A combination of factors now makes it imperative that you check patient eligibility at each and every visit. Here’s why:

• The current job market has caused a spike in the number of uninsured. People who lose their jobs often lose their health insurance coverage as well.
• Patients trying to save money are opting for health plans with lower premiums, but higher out-of-pocket costs.
• Companies are turning to higher patient deductibles and co-insurance as a way to cut costs yet still provide basic health insurance benefits.

In short: Patients now bear a greater responsibility for healthcare payments. So rather than collecting large lump sums from a fixed number of insurance companies, practices now are finding they must collect smaller amounts from many more sources (i.e., their patients). That’s why eligibility verification technology has become such an essential tool for successful RCM.

For roughly the cost of one uncollected office visit copay, eligibility verification gives you a way to ascertain upfront:

• The insurance plan to which a patient belongs;
• Whether the patient has active coverage for the type of service being rendered (e.g., office visit, psychiatric counseling, inpatient stay);
• Co-pay, co-insurance, and deductible amounts associated with the coverage; and
• Deductible amounts remaining.

With many eligibility verification solutions, for example, front desk staff simply key the patient’s insurance plan information into a Web portal and receive all of the applicable information from the payer in a matter of seconds. This can be done before patients arrive, or as they are checking in. Either way, it provides your practice the opportunity to address any potential reimbursement problems upfront.

This gives you two important benefits. The first involves the reimbursement perspective. Quite simply, it’s much easier to collect necessary fees while a patient is in the office prior to the service. Trying to collect on the back end, after a service is rendered, is much more difficult.

The second benefit is a matter of patient satisfaction. By using an eligibility verification tool you help avoid situations in which the patient is unaware of the out-of-pocket costs associated with a service. Having all the relevant facts at your fingertips lets patients make informed decisions about their care, without any financial surprises—for them or you!

Is your practice checking eligibility prior to patient visits? Share your experiences below.