Medical Billing Expert

The one thing common across patients is their lack of understanding of medical insurance coverage. Ask them about their policy and they will give back a blank look. There are a few who do understand but their understanding is shallow. It therefore falls upon you as a medical practice to verify patient insurance eligibility in advance to make sure your services will be reimbursed.

Simply put, insurance verification involves getting in touch with the insurance carrier to verify that the company covers the procedures needed by the patient. If they do, you need to obtain an authorization from the payer as a proof of consent about the patient’s eligibility. In fact, getting authorization beforehand is the safest available option to keep denials at bay. It leads to faster and efficient claims reimbursement and lesser debts.

There’s yet another important role to it. It helps in eliminating errors in patient data that commonly lead to denials taking a toll on your money and time.

Insurance verification consists of several sequential steps each of which is dependent on manual intervention. This makes the process prone to errors. Therefore, it makes perfect sense to rely on a patient eligibility verification tool. And when it comes to choosing a tool you will be spoilt for choice. In this blog we discuss the essential features that you must look for in a tool 

Seamless Integration with PMS

It always pays to integrate patient eligibility verification tool with a practice’s EHR and practice management systems. By doing so, you make data sharing between the two seamless. As a result, it’s possible to have smooth coordination between various departments. This goes a long way in making patient eligibility checking more efficient. It also simplifies tasks related to inventory management and billing. As the staff across the practice are on the same page, an error or oversight gets spotted by any one of the departments before it gets it becomes an issue.

Read Also How to Choose the Right Dental Insurance Verification Partner for Your Dental Practice?

Insurance Information Scrubbing Feature

When a patient eligibility verification tool comes equipped with this capability, it will scrub patient insurance information for errors and update it in the system. As a result, it is possible to have an updated information before the appointment. In case the information is not available, the tool will auto-trigger a task for the front office staff. The front office then calls the patient or insurance payer to fill the missing information. With updated insurance information before the appointment, it becomes easy to save time and avoid denials.

Flexibility to Resubmit Eligibility Request

Sometimes patient eligibility with a payer needs to be verified a number of times because of procedural complications. The patient eligibility tool must be flexible to allow all such requests to be submitted end number of times with updated eligibility queries. This facilitates verifying the insurance multiple times before a scheduled appointment. And in case of multiple verification, the tool must save the updated information and every verification results rather than the final one. This helps in pulling up all the results in case of denials or disputes. Also, it can help you present a clear picture during audits.

Electronic Data Interchange Submission

electronic healthcare records

Electronic Data Interchange (EDI) enables automatic data transfer between a provider and a payer. It comes with a host of benefits such as faster turnaround on information, reduced processing delays and reduced overhead expenses. The patient eligibility verification tool must allow for easy integration with EDI. This will help you submit key-entry eligibility requests to payers and gather information when there is a need to deal with appointments at the eleventh hour or meet emergency requirements. It also enables on-demand verification any time for any special requirements. Yet another big advantage of this feature is that it enables exchange of information from multiple payers at one time.

A recent report on patient eligibility found that a practice spends approximately 12.64 minutes on an average to manually verify a eligibility. The findings tell that:  
—-With manual checking your staff will be able to verify 40 patients in approximately 8.4 hours a day.
—-Manual checking will cause a practice to lose the average visit cost of 2 patients every working day.
—-At this rate practices will be able to carry out only 1,250 manual eligibility checks a year and would cost the practice an average of $6,000.  

Read Also How to Verify Patient Insurance in Three Easy Steps?

Bird’s Eye View of Benefits

Your patient eligibility tool must deliver an end-to-end view of the patient details, irrespective of their insurance. Imagine providing your team with detailed, current information about a patient! Chances are they will not commit any mistake in processing the appointment. It’s not possible for the information to be update for all the patients all the time. If the tool flags the missing field your staff will know what to do complete it. In other words, your patient eligibility tool must offer information on a platter to make insurance verification a breeze.

Allows Real Time Verification

In today’s fast paced world, real time verification makes verification instant and accurate. With real-time verification providers do not have to blindly accept the data furnished by the patient. Also, it eliminates the need to follow up with the carrier to get necessary details. besides demographics, real time verification pulls up other aspects such as co-pays and deductibles, a fair idea of the out-of-pocket expenses, approximate billing amount and other extra billing that goes with the patient preference of the mode of therapy.

Pre-Authorization Functionality.

Not obtaining preauthorization can lead to reduced reimbursements or even complete denials. It depends entirely on the provider’s agreement with the insurer as well as the coverage provided to the patient. There have been instances of insurers overturning a denial because of failure to obtain preauthorization, but it’s always wise not to take chances. A good patient eligibility tool must come equipped with the pre-authorization functionality. Such a tool will keep track of the authorization request and send an alert to the provider when the patient has no more authorizations left.

Store Insurance Verification Results in its Database:

A patient’s eligibility changes based on certain factors such as age, prevailing conditions etc. Your verification tool must assist you to track the changes in eligibility across the span of treatments availed. This is possible only if the tool can store all relevant information in its database. Such tools will help you verify all insurance verification results pertaining to the patient in tool sections such as patient info or appointment page


With the above features, your patient eligibility tool can deliver optimum benefits for your insurance verification process. Yes, you can leverage it to transform time-consuming manual processes into real-time revenue generating tool. Imagine how much your healthcare business stands to gain if you can get insurance verification completed before the appointment; get a timely nod from the payer to carry out a procedure and track in real time all benefits that are still available to the patient.

In a world marked with cut-throat competition, you can’t leave things to chance, by opting for a run of the mill tool. When you pick a tool that provides a suite of the above-mentioned features, you leave all eligibility related worries behind.

Who We Are and What Makes us An Insurance Verification Expert?

MedBillingExperts is a specialized provider of back office support services for US-based hospitals and clinics. We specialize in a range of support services primary among which is insurance verification services. We have a proven track record of assisting our clients get the most accurate insurance policy benefit information along with authorization and precertification, prior to an appointment or admission. All our experts have vast exposure to prior authorization procedures which is why they have inside out knowledge of medicare, medicaid, and other payers verification requirements.


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