Use this banner to inform your visitors of something important.
Blogs

7 Insurance Eligibility Verification Mistakes That Can Impact the Revenue Cycle

Paul Marin
,
Director of Payer Partnerships
December 18, 2024
OA Editorial Team
,
Publisher
December 18, 2024
Woman checking in to healthcare practice

Insurance eligibility verification is a crucial first step for any medical practice. However, even small mistakes in this process can cause big problems. These errors can slow down your payments, lead to claim denials, and create extra work for your staff. Here are seven common mistakes that medical practices should watch out for.

1. Not Verifying Insurance Before An Appointment

Failing to verify insurance before an appointment is a very common mistake. While it's an easy error, it can cause big problems later. You might only learn afterward that the patient’s insurance is inactive or doesn’t cover the services they received. This issue can result in a rejected or denied medical claim, meaning your practice doesn’t get paid for the work you did. Even if the claim is eventually paid, the delay can make it hard for your practice to manage its cash flow.

To avoid these issues, make it a habit to check insurance before every appointment. Using tools that check insurance eligibility electronically is a good practice. Early insurance verification protects your practice's income. You also help patients avoid unexpected bills. For these reasons, you should make insurance checks a regular part of your revenue cycle management. Doing so can reduce payment problems and keep your practice running smoothly​.

2. Inaccurate Patient Information

Another common mistake is having inaccurate patient information on file. Even small errors, like a misspelled name or an incorrect date of birth, can cause issues for insurance eligibility verification. This information must match the patient’s Electronic Health Records (EHR). It also needs to be an exact match of their insurance documents. A mismatch can lead to errors that stall the claims process. When claims are delayed, so are reimbursements, which can hurt your practice’s cash flow.

To prevent these problems:

  1. Double-check all information entered into your system. 
  2. Encourage your staff to take their time when inputting data. 
  3. Consider using software that automatically flags common errors. 

Catching mistakes early will prevent them from causing bigger issues later. Reducing data entry errors helps maintain an accurate billing process.  It will also help ensure your practice gets paid on time.

3. Incorrect Insurance Information

Having incorrect insurance information on file is another common mistake. If the policy number, group number, or coverage details are wrong, it can lead to rejected claims and delays. Insurance companies need accurate information to process claims correctly. If they receive incorrect details, the claim might be rejected. When this happens, you’ll have to spend extra time fixing the errors and resubmitting the claim.

To avoid this, always double-check the insurance information you have on file. Make sure every detail matches what’s listed on the patient’s insurance card. Confirm this information during each visit. Doing so reduces the risk of mistakes that lead to payment delays. Ensuring accuracy in this area is a simple yet effective way to protect your practice’s income. To help with this, consider using a clearinghouse for verifying and processing claims. This step streamlines the process and catches errors early​.

4. Changes in Patient Insurance Policies or Coverage

Insurance coverage can change at any time. If your practice isn’t aware of these changes, billing issues can arise. Patients might switch jobs, move to a new plan, or have changes in their coverage that you’re not informed about.

Not using real-time eligibility checks can cause delays and mistakes in billing. If your practice uses old methods to check insurance, you might miss changes in coverage. Without real-time checks, you could end up providing services that aren’t covered. This oversight leads to denied claims and surprise costs for the patient.

Also, be sure to ask patients about changes to their insurance each time they visit. Regularly updating this information ensures that your billing process remains accurate. This simple step helps you avoid the frustration of having to correct and resubmit claims. It keeps your practice’s finances stable and avoids unnecessary delays in payment.

5. Insufficient Training of Staff

Having well-trained staff is crucial to avoiding mistakes in insurance eligibility verification. Your team must be properly trained to verify insurance, input data, and handle claims. If they are not, errors may lead to claim denials, delayed payments, and extra work for your practice. Untrained staff may also miss changes in a patient’s coverage or policy. These errors can further complicate the billing process.

To prevent these problems, ensure all staff members receive thorough insurance verification training. Regularly update training to keep up with changes in insurance policies and technology. Investing in staff education reduces errors and improves efficiency. Well-trained staff can better handle the complexities of insurance verification. They ensure claims are processed smoothly and payments are received on time.

6. Poor Provider & Patient Communication

Clear communication between providers and patients is essential for accurate insurance verification. Insurance coverage details might be missed when there is a lack of communication. For example, a patient may not inform your staff about changes to their insurance. Miscommunication can lead to denied claims or unexpected bills.

To improve communication, routinely ask patients about insurance changes every visit. Explain why it’s important for them to share accurate and current information.

Your staff must also clearly communicate to ensure all details are recorded correctly, and everyone is on the same page. Good communication is the first step in avoiding errors. It streamlines the verification process and reduces the chances of claim denials.

Incorporating insurance eligibility verification tools also assists in this process. They can provide accurate, real-time information that providers and patients can rely on​.

7. Not Asking About Secondary Insurance Policies

Some patients have more than one insurance plan. If your practice only bills the primary insurance, you miss additional coverage. This oversight can result in higher out-of-pocket costs for the patient. It can also cause a longer billing process for your staff.

Always ask patients if they have any secondary insurance during their visit. Record this information accurately and bill all insurance plans in the right order. Doing so ensures your practice receives full payment and patients don't receive unexpected bills.

Insurance eligibility forms that ask about secondary insurance can help. They can make the verification process easier and help prevent billing errors​.

Insurance Eligibility: A Key First Step in the Revenue Cycle

Insurance eligibility verification is vital in managing a practice’s revenue cycle. Always confirm a patient’s insurance is active and covers the services they need. Doing so ensures your practice gets paid on time. Missing this step or making mistakes can cause significant problems. It may lead to denied claims, delayed payments, and extra work for your staff.

Making insurance verification a routine and practice policy can save time for your staff. It can also prevent headaches down the road. It helps your practice run smoothly and improves cash flow. It keeps patients happy by avoiding unexpected bills. Ensuring accurate insurance eligibility should always be a top priority.

If you want to streamline your insurance verification process, consider using Office Ally. Our tools are designed to make managing your revenue cycle easier and more efficient. Plus, with our competitive Office Ally pricing, you can find a plan that fits your practice’s needs.

Take the first step toward improving your practice’s financial health.

Paul Marin

Director of Payer Partnerships

Paul Marin, Senior Director of Clearinghouse Success at Office Ally, leads initiatives to optimize healthcare workflows for Providers, Trading Partners, and Healthcare Service Organizations. With a focus on efficiency and accessibility, he crafts strategies that resonate with medical professionals. Paul's dedication aligns with Office Ally's mission to revolutionize healthcare.

OA Editorial Team

Publisher

We are Healthcare's Ally. We are here to support healthcare providers and payers with high-value software solutions that are reliable, affordable, and easy-to-use.