In healthcare reimbursement, the first and most critical step is collecting patient demographic and insurance information and verifying that those benefits are indeed available to the patient. Whether care is being accessed in a hospital setting, outpatient facility, or a provider practice, insurance eligibility must be determined to be valid and benefits verified to ensure maximum reimbursement is captured.

Additionally, many procedures and tests are performed at specialty practices or ancillary sites, with patients often arriving unscheduled. In these situations, insurance verification must be completed in real-time to ensure correct co-pays and co-insurances are collected upfront. With more and more patients opting for high deductible healthcare plans, this process has reached a critical phase in the healthcare payment lifecycle.

Automated Insurance Verification Benefits

With an automated, real-time insurance verification and benefits solution that works with your existing EHR/EMR system, you can authenticate the patient’s available benefits and discover remaining deductible amounts, procedures, and tests covered, and annual maximums reached. This will benefit your organization in the following ways, all culminating in improved reimbursement capture and bottom-line results:

  • Real-Time Data Available Instantly—Today, through Health Level 7 (HL7) technology, clinical and administrative data can be safely and securely shared between applications meaning that once a patient’s insurance eligibility and benefits have been determined, they can be accessed for scheduling and reimbursement management purposes. HL7 allows integration of patient data from separate silos into a cooperative information system maximizing patient care and outcomes, and the payment and collection process.

  • Scheduling and Walk-In Benefits to the Patient—It is especially imperative to have a seamless insurance verification and benefits solution in facilities where patients arrive accompanied by information previously collected by the ordering provider (and not always correct), such as specialty practices, labs, and imaging centers. Additionally, these sites may schedule appointments or receive patients as walk-in clients with the expectation of immediate service.

    In these cases, real-time access to verified information reduces the administrative burden of manual eligibility verification. It reduces rework during the revenue cycle management (RCM) phase through claim denials and rejections. This also has a positive effect on the collections process, with patients paying accurate estimations at the time of collections.

  • Reimbursement Improvements—With precise and timely information at your fingertips, the reimbursement process is simplified, claim denials are reduced, and payment velocity is increased substantially. Real-time insurance verification allows your RCM team to increase efficiencies and collections while significantly decreasing rework and additional handling of claims due to denials.

In case you think this doesn’t affect your organization, according to the Healthcare Financial Management Association (HFMA), the average cost to rework a denied claim is over $25.00, and as many as 65% of denied claims are simply abandoned. With an effective, upfront verification solution, many of these denials can be alleviated, and reimbursement can be sped up and captured.

Securing revenue for testing performed is second only to patient care in ensuring a thriving organization. With today’s technological advancements in automation and artificial intelligence, processes such as insurance verifications and benefits and patient pay estimate solutions, coupled with prior authorizations, are launching an industry-wide reimbursement revitalization that flows directly to the bottom line. Hospitals and practices are in a much more proactive stance with easy-to-use technology to manage their insurance carrier contractual relationships and increase revenue flow.

Contact us today to talk about automating your insurance verification and benefits processes along with other patient access tasks, such as prior authorizations.