This One Step Can Streamline Your Medical Billing Process

[Eminence RCM]

This Blog Was Originally Published on Eminence RCM

https://eminencercm.com/blogs/this-one-step-can-streamline-your-medical-billing-process

“The First Step Towards Revenue Cycle Success Starts with Accurate Insurance Eligibility Verification”

Taking charge right from the beginning can make a lot of difference in medical billing. A little care in the administrative process can help physicians and hospitals achieve adequate revenue.

This brings attention to a vital step in medical billing which is insurance eligibility verification.


Conducting this step with precision will not only ease further steps but also lead to a streamlined reimbursement flow. This step simply means verifying the insurance policy of a patient before rendering medical services.

In this blog, we will understand this concept better and learn how it dictates the entire medical billing process.

Let's begin by establishing the fact of why this step is crucial!

Need To Prioritize Insurance Eligibility Verification​

Dismissing important steps at the beginning of the process can pose trouble at the time of collection. Even though administrative tasks need to be performed quickly, this one step must be with complete accuracy.

When healthcare providers pay attention to verification, they optimize their overall process leading to less stress and quality patient care.

In situations where healthcare providers are not able to handle it themselves, they outsource medical billing and coding from any reliable medical billing company.

Here are the three main reasons that make verification important:

Getting Adequate Revenue Without Any Hassle​

When a patient's insurance policy doesn't have enough medical coverage, it prevents healthcare providers from receiving adequate revenue. Not checking this fact at the right time puts healthcare providers in a difficult situation.

Checking insurance availability is all that healthcare providers need to do to protect themselves from being short of finances. That is why this is the first step in medical billing and coding.

Attaining Pre-Authorizations In A Short Time​

Time is the driving factor for pre-authorizations and delays are not preferred by insurance companies. Timely insurance eligibility verification also accelerates getting pre-authorizations.

Getting both these requirements sorted before patient consultation is beneficial for healthcare providers. Even though these concepts are not directly related, they impact each other in terms of proceeding with patient treatment.

Enhancing The Rate Of Clean Claims​

Verification for checking insurance eligibility is also linked to enhancing the clean claim rates. Nothing can be better for healthcare providers and practices if they can optimize their medical billing. This is possible with proper planning and execution.

This happens because scrutinizing insurance claims helps in choosing the right one in case a patient has more than one plan.

The role of insurance eligibility verification is vast, and this process is also challenging. To counter this, healthcare providers usually find ways to deal with this effortlessly. Here, medical billing services come into the picture, as they solve the issues and improve revenue cycle management.

Verification is not only essential for healthcare providers, but it also offers various advantages to patients.

Benefits Of Insurance Eligibility Verification To Patients​

Not just healthcare providers but patients are also under a lot of stress before going for any medical treatment.

In this case, if their verification is done without any hassle, it relieves them of the burden. Earlier verification also helps them in analyzing their financial responsibility.

Proper handling of an insurance policy is a win-win situation for both healthcare providers and patients.

This also helps in making patients more satisfied with the service as they don't have to undergo a lot of trouble. Where healthcare providers can achieve adequate revenue, simultaneously they are also meeting the goal of addressing patients effectively.

Step-By-Step Verification Process​

First and foremost, is realizing the need for eligibility verification and organizing a process for the same. All other steps begin after this part of the process is already established.

This involves manually checking the insurance policy and connecting with the insurance company to verify the document's eligibility. Based on a patient's requirement, this can take more than a few minutes.

Let's see how the process goes and understand the details:

• Eligibility verification starts with collecting patient details such as name, insurance provider, date of birth, and other vital information.
• After this, you need to check the insurance card and confirm details both on the front and the back.
• The next step includes updating that information in the health records (EHR or EMR).
• These tools have built-in features that support insurance eligibility checks.
• Healthcare providers need to check various data and that is -
  1. Insurance Policy Holder's Name
  2. Expiry Date of the Policy
  3. Copay and Coinsurance
  4. Deductibles for the Patient
  5. Need for Pre-authorization
  6. Out-of-network Insurance Providers
  7. If the Plan Has No Coverage for Specific Treatment

Proper insurance eligibility verification needs precision and often healthcare providers do not have enough time to go step-by-step.

This creates a gap that can be easily bridged with the help of medical billing services. They offer medical billing and coding services based on the unique requirements of your healthcare practice.

Importance Of Outsourcing Medical Billing Services​

Strengthening revenue cycle management begins with taking every medical billing step seriously. Focusing on ensuring accuracy and efficiency is what makes a healthcare practice successful.

Insurance eligibility verification poses numerous challenges for healthcare providers and prevents them from attaining adequate revenue. That is why they need a one-time solution, to save their time and energy in dealing with this complex task.

Medical billing services can streamline the verification process and elevate overall performance. Let's see how outsourcing can help healthcare providers and practices:

• Choosing services gives more time to spend on patients. This builds trust between patients and healthcare providers and makes medical care more reliable.
• The services work proactively and take all measures on time. This protects the healthcare providers from the consequences of not acquiring prior authorization.
• Proper verification saves much time as it reduces the number of denials, increases clean claim rate, and saves healthcare providers time and resources.

Bottom Line​

Healthcare providers and practices can significantly improve their bottom line by paying attention to insurance eligibility verification. Where this is a significant goal, another major objective is providing quality patient care. In this case, medical billing services can help healthcare providers in dealing with complex verifications while healthcare providers take care of patients.

Eminence RCM is a medical billing company in USA providing insurance eligibility verification for various healthcare providers and practices. We work with an expert team that handles the intricate insurance verification process with precision. Not just that, we take responsibility for HIPAA compliance, denial management, claim processing, and follow-up.

Our services are focused on navigating through challenges like improper insurance verification, errors in coding, delays in claim filing & submission, and lack of denial management. We improve the workflow, eradicate manual errors, and optimize revenue cycle management.