Missed Insurance Eligibility Checks: Costs & Financial Implications

An insurance eligibility check verifies whether a patient’s health insurance covers specific medical services. These checks ensure your practice can provide efficient insurance eligibility healthcare solutions. 

The 2022 CAQH Index report highlights that electronic insurance eligibility verification can save 14 minutes per transaction for medical practices. The resulting cost savings amount to $12.8 billion across the industry. Based on this data, it's clear how necessary these checks are in maintaining your healthcare practice’s financial stability and service efficiency.

Failing to check patient eligibility prior to service can severely impact healthcare providers and their patients. These impacts include claim denials, disrupted revenue cycles, increased administrative burdens, and adverse patient experiences.  Let’s explore how each of these can impact your practice below.

The Implications of Missed Insurance Eligibility Checks

Claim Denials

Improper insurance eligibility verification can increase claim denials. Medical claims may contain incorrect coverage information when eligibility is not confirmed upfront. This mistake delays reimbursements and adds a significant workload. As a result, denials can seriously impact a medical practice’s financial health.

Late & Missed Payments: Unpredictable Revenue Cycle 

When practices aren’t able to electronically check insurance eligibility, it often leads to late and missed patient payments. This issue is another factor that can disrupt a practice’s financial health. 

Administrative Burden 

Inefficient insurance verification processes significantly increase administrative overhead. Relying on manual methods, like calling each payer, consumes valuable staff time and resources. Even worse, it complicates routine operations and increases the likelihood of errors. These can strain a healthcare practice’s overall efficiency.

Missed Checks Lead to a Negative Patient Experience 

Inadequate insurance eligibility processes have a severe impact on patient satisfaction and trust. When patients face unexpected costs due to eligibility issues, it confuses and diminishes their confidence in their healthcare provider. The result is often a practice that cannot provide services, or the patient goes elsewhere because of a lack of trust.

Reasons Insurance Eligibility Checks Might Not Be Happening

Missed insurance eligibility checks can result from specific administrative issues within a practice. Consider some of the following scenarios:

• Lack of Verification Software: Calling each insurance provider in order to verify eligibility can be impossible in a busy healthcare practice, but software can help automate this process. Even if your practice doesn’t have the ability to automatically send a Healthcare Eligibility Benefit Inquiry (or 270 transaction), some online tools give you the option of using direct data entry to verify eligibility.

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• Technological Lapses: Technology significantly enhances the verification process. However, you must keep systems current and have backup options in place. That way, you can still perform accurate verifications even if your main system fails. 

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• Incomplete Payer List: Your practice needs a comprehensive payer list for eligibility to ensure accurate insurance verification. Without a payer list, insurer information might be incomplete or out-of-date, making it easy to overlook eligible coverage.

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• Lack of Routine Verification: Practices might not include eligibility checks in their workflows for other reasons. One reason might be that they underestimate the benefits. They might be unaware of the financial and administrative impact of not performing these checks.

These scenarios illustrate the importance of using sophisticated and reliable healthcare solutions. Accuracy in the insurance eligibility verification process simplifies a practice’s workflow and protects it from financial discrepancies caused by errors.

Automate Your Insurance Eligibility Checks for Reduced Errors

Leveraging insurance eligibility software dramatically enhances your practice’s ability to check health insurance eligibility online. By integrating this software, your practice can automate the verification process. Automation is an essential step in minimizing errors and increasing administrative efficiency.

‍Office Ally’s healthcare solutions simplify your practice's administrative tasks and improve patient care. Our insurance eligibility software streamlines the insurance verification process. With this tool, your staff can quickly and accurately verify patient coverage. The result is a reduced risk of claim denials and ensured timely payments.