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What Are The Measures To Optimize Healthcare Insurance Eligibility Verification Process?

Healthcare Revenue Cycle Management (RCM) is the process of managing the patient data and the financial status of the organizations. This involves handling Medical data and patient information, storage and retrieval as and when required. The information provided by the Patient pertaining to their personal and insurance payor needs to be verified for accuracy and completeness prior to rendering the service as this can directly affect your financial system. This explains why Insurance Eligibility Verification needs to be the first step of your RCM process.

Insurance Eligibility Verification


Before analyzing the measures to Optimize Insurance Eligibility Verification, let us look down on the benefits and detriments of having or not having this process in our RCM flow.

Why Insurance Eligibility Verification is Important? :

Revenue Cycle Management involves meticulous details and information that tends to change and vary upon any given situation. This ever-changing nature of the Medical data inclusive of patient demographic details and insurance coverage information, arises the need to be checked and analyzed per every patient visit and per every service rendered. It is advisable for any Medical Billing Company to have stringent measures to ensure the information in the claims submission is accurate and complete to avoid claim rejection and denial percentage. An effective Insurance Eligibility Verification team will ensure the following is confirmed prior to the procedure.

·         Confirm the patient details and coverage benefits during each visit. This eradicates claims denials due to any changes in the existing data or information.

·         Ensure the patients Demographic details are up-to-date

·         Verification of Insurance Coverage and validity to ensure the procedure to be provided is covered

·         Prior Authorization and Referral numbers if required.

·         Patient’s responsibility, copay coinsurance and deductibles details are checked to be discussed with the patient to avoid surprise billing

·         Verify if In-Network or out of network services so the medical team can get the patient’s consent as required. 

Benefits of Insurance Eligibility Verification

Insurance Eligibility Verification ensures an efficient RCM process, thereby reducing the chances of claims denials and rejections. Proper verification also helps in curbing wanted write-offs and make sure collection of patient responsibility upfront. Substantially, it assures increased cash flow and Efficient Workflow. 

Measures to Optimizing Insurance Eligibility Verification

Optimizing or enhancing Insurance Eligibility Verification is an essential part if your claims denial percentage is aggregated or if your medical claims reimbursement percentage has taken a hit of late. By optimizing the verification approach required results can be fetched without affecting the Client satisfaction and the bottom – line of your business. Here are some measures to Optimize Insurance Eligibility Verification process.

·         Double-check Patients Demographic details and Insurance Coverage details by checking Insurance web portals, calling the Insurance Company, Patient, verifying through emails etc.

·         Ensure Patients data is cross-checked for accuracy and edited with any updates or changes

·         Cross-check Fee scheduled with an allowed amount to ensure your charges comply with the recent and updated charges per procedure

·         Integration of patient scheduling with Practice Management system to ensure automation of upcoming schedules and appointments

·         Advanced and the automated tool can help reduce man-effort and increase qualitative and quantitative results. 

 About e-care

e-care India is one of the top Offshore Medical Billing Companies based in India that promises to avoid claim rejections and denials with our Optimized Insurance Eligibility and Benefits Verification. With over two decades of experience in the industry, e-care’s 3 delivery centers have been providing end-to-end medical claims processing services seamlessly to its clients. We ensure maximized monthly collection and reduce denials due to an incomplete or incorrect patient or coverage details. To know more about e-care and its services, log on to www.ecareindia.com

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