Importance of Insurance Eligibility Verification in the Medical Billing Process?

Insurance eligibility verification is an essential step which needs to be carried out before the patient is admitted at the hospital for their medical treatment. It is a step that involves, directly contacting the patient’s insurance provider and checking whether the patient’s healthcare insurance plan covers expenses for the medical procedures. This prevents the scenario […]

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Insurance eligibility verification is an essential step which needs to be carried out before the patient is admitted at the hospital for their medical treatment. It is a step that involves, directly contacting the patient’s insurance provider and checking whether the patient’s healthcare insurance plan covers expenses for the medical procedures. This prevents the scenario where the patient is charged expensive medical bill or where the medical claim is left unpaid. Thus, insurance eligibility verification is a procedure of determining the patient’s insurance coverage status.

The following are the reasons that this step is important during the medical billing process:

  • Better Cash Flow

When insurance eligibility verification is carried out in the right manner, it enhances cash flow of the healthcare provider. This is because, this step helps confirm whether the patient’s insurance plan is active or not, and verifies whether they are supported by their insurance plan to cover some or all medical procedures. The insurance plans usually specifies the medical procedures that they cover. This increases the chances for clean claims since there will be lesser confusions regarding paying off the medical bills on time. More the rate of clean claims, better the revenue collection for the healthcare provider.

  • Reduced Claim Denials and Rejections

When the insurance eligibility verification is carried out successfully, the patient’s current insurance details are updated. This would reduce the possibilities of claim denials due to inaccurate patient insurance details. As a result, patient payment delays would be reduced which would mean, a healthy financial status for the healthcare provider. Therefore, this step of insurance eligibility verification must be carried out every single time the patient visits the healthcare provider. This is to ensure that, any changes in the patient’s insurance plan is updated, verified and validated. If these change in insurance details are not updated and filled onto the claim, it will be denied upon submission.

  • Enhances Patient Satisfaction

Patient insurance eligibility verification helps maintain transparency of total medical costs that could incur for the patient after their insurance provider pays partial or full amount of medical costs. The patient’s insurance provider pays for only those medical procedures that are a part of the chosen insurance plan of the patient. Another factor that adds on to the patient’s personal bills would be, if the physicians who treated the patient were out-of-network with the patient’s insurance provider. The bills charged by out-of-network physicians will not be covered by the insurance provider, nor will the costs for medical procedures that were not a part of the patient’s insurance plan. Thus, insurance eligibility verification provides patients with an estimate of the costs that they will have to pay on their own. It will give them enough time to arrange money if required and prevent the chances or surprize expensive bills for the patients.

In the process of medical billing, Insurance eligibility verification helps improve the overall revenue for the healthcare provider. It streamlines workflow and enhances the patient experience. Thus, it is a step that is an integral part of the medical billing process that guarantees timely reimbursements for healthcare providers.

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