5 Steps for Integrating Patient Eligibility Verification Into Your RCM

Revenue cycle management (RCM) is the financial process that healthcare facilities use to track patient care from registration and appointment scheduling to the final payment of a balance. Integrating patient eligibility verification early in this cycle is crucial. It ensures that services provided to patients are covered by their insurance, thereby minimizing claim denials and delays in payment.

5 Steps to Integrate Patient Eligibility Verification into RCM

The following steps outline how you can effectively embed this process in your practice. In the sections below, we’ll explore each step that can help you get started in establishing a robust system for patient insurance eligibility verification.

Step 1: Properly Train & Educate Your Staff on Eligibility Verification

Training your staff thoroughly in patient insurance verification is the first critical step to integrating it effectively within your RCM processes. Consider using an insurance eligibility verification solution to help along the way. Using this technology ensures that providers check each patient's insurance status accurately before rendering services.

Ensure that all team members understand the impact of accurate eligibility verification on the practice’s financial health. A well-trained staff contributes to smoother billing processes and enhances patient satisfaction by minimizing billing errors and delays.

Step 2: Verify Patient Eligibility for Every Patient Visit

Verifying patient eligibility on every patient encounter is a crucial early step in the revenue cycle management (RCM) process. Ensuring that patients are eligible for their health insurance coverage helps reduce errors and delays in claim processing. The most important question is how often to verify patient eligibility.

Verify Eligibility at the Time of Scheduling the Appointment. 

When a patient schedules an appointment, verify their insurance coverage immediately. This initial check helps identify any potential issues early on, allowing your staff to address them before the patient arrives. 

Confirm the insurance plan is active and that the services to be provided are covered under the patient’s plan. This step reduces the likelihood of coverage surprises on the day of the appointment. 

Re-verify Eligibility a Few Days Before the Appointment. 

Perform a secondary verification 48 to 72 hours before the scheduled appointment. This re-verification accounts for any changes in the patient’s insurance status that may have occurred since booking.

Ensure that the patient’s insurance information is still valid and that there have been no changes in coverage, such as policy cancellations or changes in the benefits structure.

Verify Eligibility Again Upon Patient Check-In

Conduct a final eligibility check during the patient check-in process on the day of the appointment. This last-minute verification ensures that the insurance information is up-to-date and that there are no new issues.

Confirm details such as copayments, deductibles, and any changes in coverage that might affect the billing process. Having this information on hand helps in collecting accurate copayments and reducing billing errors.

While this simple yet effective strategy is foundational in modern RCM practices, making it indispensable in today’s healthcare settings, it is surprising how many practices have yet to adopt it as part of their workflow. Providers who prioritize this issue can help protect their operations against common financial pitfalls.

Step 3: Use a Patient Eligibility Verification Software

In the last section, we briefly discussed the importance of verifying eligibility for every patient visit. This can be overwhelming, but patient eligibility software can be a game-changer for any healthcare practice. This technology streamlines the verification process and ensures that the information is accurate and updated. 

What Data Should Be in an Eligibility Response*

• Patient’s current insurance status.
• Coverage details including copayments, deductibles, and co-insurance.
• Policy effective and termination dates.
• Specific benefits covered under the plan.

* Some of this information may not be available depending on what is returned by the individual insurance provider. However, it is important to verify as much information as possible to make sure your claims are as accurate as possible.

Choosing the right software involves evaluating several factors, including compatibility with your current systems, ease of use, and the number of payers you bill for that are available on the system. Investing in the right solution will empower your practice to manage eligibility more effectively, ensuring financial stability and patient satisfaction.

Step 4: Leverage Electronic Health Records

Incorporating patient insurance eligibility verification into your electronic health records (EHR) system is a powerful way to enhance your healthcare solution. By doing so, you can centralize patient data and streamline medical claims processing, making it faster and more accurate.

EHR systems that integrate eligibility verification help ensure that all patient information is updated and accessible in real-time. This information is crucial for medical claims processing. Providers can instantly verify insurance coverage as part of the patient check-in process. This reduces the risk of claim rejections due to data errors or outdated information.

Furthermore, leveraging EHRs for eligibility verification supports a more coordinated approach to patient management. It enables healthcare teams to access comprehensive patient records, including insurance information, which facilitates better decision-making and improved patient care.

Step 5: Collect Copayments and Deductibles Upfront

Collecting copayments and deductibles at the time of service is critical for maintaining a healthy revenue cycle. This step ensures the practice promptly receives necessary funds and reduces the risk of bad debt. Let’s look at some of the benefits.

Improved Cash Flow

By collecting copayments and deductibles upfront, practices can significantly improve their cash flow. This immediate influx of funds helps cover operational costs and reduces the dependency on patient billing and collections processes.

Practices can allocate resources more effectively, focusing on providing quality care rather than chasing payments.

Reduced Bad Debt

Collecting payments at the point of service minimizes the risk of non-payment. Patients are more likely to pay when services are rendered, reducing the likelihood of accounts receivable turning into bad debt. 

Enhanced Patient Understanding

Discussing copayments and deductibles upfront enhances patients’ understanding of their financial responsibilities. Clear communication regarding costs helps manage patient expectations and reduces confusion or disputes over billing. Patients are more likely to appreciate the transparency and may be more willing to comply with payment policies.

Streamlined Billing Process

Upfront collections simplify the billing process, reducing the administrative burden on staff. With fewer outstanding balances to manage, the billing team can focus on more complex claims and follow-ups.

Patient Eligibility Verification Impacts Revenue Cycle Management

Integrating patient eligibility verification effectively into your RCM strategy can have profound effects on your healthcare practice's operational and financial performance. This integration can help streamline the billing process and directly impact the financial health of your practice. Some of the benefits that underscore the importance of having eligibility verification include:

• More Clean Claims, Less Claim Denials
  Ensuring eligibility upfront reduces the number of denied claims due to coverage issues.
• Improve Reimbursement Rate & Prevent Revenue Loss
  Accurate verification leads to quicker and more complete reimbursements, reducing the chance of revenue losses.
• Enhance Financial Health & Cash Flow
  With faster claim processing and fewer denials, your cash flow remains consistent and predictable.
• Satisfy & Retain Your Patients
  Patients experience fewer billing surprises, leading to higher satisfaction and loyalty.

Each of these benefits contributes to a stronger and more resilient revenue cycle, ensuring your practice remains financially healthy and focused on providing excellent patient care.

How Office Ally Helps with Patient Eligibility Verification

Office Ally offers patient eligibility verification software that simplifies checking eligibility through its clearinghouse. This software connects directly to an extensive payer list, enabling healthcare providers to verify insurance coverage quickly. By integrating with EHR 24/7 or your existing systems, Office Ally’s solutions simplify the verification process, reduces administrative burdens, and helps ensure that your claims are clean and compliant. Get started with Office Ally and watch your revenue cycle improve today.