The Importance of Patient Eligibility Verification in RCM

Revenue cycle management (RCM) involves collecting payments from patients or insurance companies for healthcare services. Effective revenue cycle management can help prevent billing loss. You can improve your RCM by performing patient eligibility verification to confirm your patient’s insurance coverage before providing medical services. Physician Practice Specialists can provide revenue cycle management consulting to help you create successful systems.

How Patient Eligibility Verification Can Benefit Your Practice

 Verifying a patient’s insurance before providing services can help you:

Prevent Revenue Loss

Failing to verify that a patient’s insurance information is correct and current can lead to denied claims. Denials may result in revenue loss for healthcare providers due to the treatment time and materials spent on the patient. The resulting billing time and resources can also be expensive. Verifying patient eligibility before providing services reduces expensive billing errors and rejected claims, which can improve cash flow and reduce debt.

Estimate Costs Accurately

Patient eligibility verification allows healthcare providers to estimate the patient’s out-of-pocket costs more accurately. This transparency is appreciated by patients and prepares them for the billing process. It also gives them time to decide whether it is a good time for them to receive the treatment. This process can prevent patients from receiving an unexpectedly high bill and helps make sure you spend time treating patients who are eligible for your services.

Improve Patient Experience

Confusion about your patients’ insurance coverage or billing disputes can cause unnecessary stress for them. Utilizing an effective patient eligibility verification system can help avoid these situations and prepare the patients for their bills. This may lead to higher satisfaction levels, which can reflect positively on your practice.

Remain Compliant

Inaccurate billing practices can lead to legal or regulatory penalties. Patient eligibility verification can confirm that your billing process follows industry regulations, possibly protecting you from potential legal complications. These complications can include financial penalties, and have a negative impact on your revenue cycle management.

Prevent Fraud

A criminal may commit medical identity theft and fraud by using a different patient’s identity and insurance coverage. By verifying patient eligibility, you can prevent fraud and financial abuse. These efforts can protect the healthcare system, the patient’s identity, and your own revenue.

Enhance Cash Flow

Revenue cycle management helps verify that claims are paid as quickly as possible. When you are being reimbursed promptly, you may have more cash to cover operating expenses. This can improve the overall financial stability of your practice.

Methods for Verifying Patient Eligibility

Verify a patient’s eligibility before providing services to them. This can help confirm that you receive payment for the services that you provide, which protects your revenue cycle. There are multiple ways that you can verify a patient’s eligibility, including:

Checking Directly With the Insurance Company

While it may be the most time-consuming option, you can choose to call a patient’s insurance company directly. This method allows you to verify the patient’s enrollment and get detailed information about their policy and benefits. An employee from your practice should verify patient insurance before providing services. After initial verification, you may also want to verify each patient’s insurance periodically to make sure their coverage did not change. 

Use a Patient Eligibility Verification Service

You can also choose to use a third-party eligibility verification service. These services can handle patient eligibility verification and may also provide other services like claim filing and collection. Choosing this option can free up your employees’ time to complete other tasks.

Use an Electronic Health Record (EHR) System

Electronic Health Record (EHR) systems are often used to keep track of patient medical information, including their history, diagnoses, and test results. They may also come with eligibility verification capabilities. This can make it easier to verify patient eligibility at the point of care and may enable you to verify patients automatically before an appointment. We offer revenue cycle management consulting to help you find an EHR that meets your needs. Having worked with over 50 EHRs over the years, we have two that we recommend based on your specialty and the services you provide. 

We can help you decide on an EHR or patient eligibility verification service if you sign up for a consultation. These tools can improve your revenue cycle management and improve your practice’s cash flow. 

Revenue Cycle Management Consulting Services To Help Prevent Revenue Loss

If you want to prevent revenue loss within your practice, consider verifying patient eligibility before providing care for your patients. Physician Practice Specialists offers revenue cycle management consulting services to help you set up an effective system for verification. These systems can allow you to provide accurate cost estimates, remain compliant, and help prevent fraud.

With assistance for your RCM, you can focus on developing your practice in other ways. Physician Practice Specialists allows you to optimize your billing services without overspending. Schedule a consultation today.