7 Benefits of Insurance Eligibility Checks Before Patient Visits

#healthcareRevenueCycleManagement, #MGMA,

As per the Medical Group Management Association’s (MGMA) Annual Regulatory Burden Survey 2022, medical practices face overwhelming regulatory challenges in revenue collections. Healthcare enterprises have to work harder and harder to collect the money owed to them, and administrative costs have increased substantially. One way to reduce the administrative burden of revenue collection is performing insurance eligibility checks prior to each appointment.

Here are some of the 7 great reasons  for conducting insurance eligibility checks before you see patients at your medical practice:

  1. Verify Coverage Status: Insurance eligibility checks help to verify whether the patient’s insurance coverage is active and valid at the time of their visit. This prevents any unpleasant surprises for both the patient and the medical practice, ensuring that the patient’s insurance will cover the services they receive.
  2. Reduce Financial Risks: Without insurance eligibility checks, there is a risk of providing services to patients who do not have active insurance coverage. This could lead to denied claims or unpaid bills, leaving the medical practice to bear the financial burden. By verifying insurance eligibility beforehand, you can minimize the risk of providing services that may not be reimbursed.
  3. Improve Revenue Cycle Management: By knowing the patient’s insurance coverage in advance, you can accurately determine the patient’s financial responsibility, including copays, deductibles, and any out-of-pocket expenses. This enables the practice to collect payments promptly and avoid later billing issues.
  4. Enhance Patient Experience: When insurance eligibility is checked before the appointment, any discrepancies or issues can be resolved in advance. Patients will appreciate the smooth administrative process, reducing wait times and frustrations during their visit to your office.
  5. Avoid Rescheduled Appointments: When patients know what they owe, they will likely ensure they have the funds to meet the expenses before they come in for an appointment. This ensures that the patient’s visit goes smoothly without unnecessary delays or rescheduling due to administrative issues.
  6. Comply with Legal and Contractual Obligations: Many insurance contracts require providers to verify eligibility before providing services. Failure to comply with these requirements could lead to contract violations and potential legal issues.
  7. Prevent Medical Billing Errors: Verifying insurance eligibility helps reduce billing errors, such as submitting claims to the wrong insurance company or using outdated information. This leads to quicker claim processing and faster reimbursement for services provided.

In conclusion, conducting insurance eligibility checks before seeing patients is a critical step for medical practices to ensure smooth operations, improve revenue cycle management, enhance patient experience, and avoid financial risks and legal issues. It ultimately benefits the practice and the patients by promoting efficiency, accuracy, and financial transparency.

Insurance eligibility checks can be integrated into the practice’s electronic health record (EHR) system, making it easier to access patient information and verify coverage. This streamlines the administrative process, allowing staff to focus more on patient care. If you need further assistance with this process, consider outsourcing insurance eligibility checks to an experienced medical billing service.

As a medical coding and billing service (that has worked with hundreds of medical practices and healthcare organizations over the last two decades), we know that revenue cycle management is one of the most daunting aspects of medical practice ownership. After all, the sustainability of your medical practice depends on how accurately you bill and how much of the billed services you can collect. We are here to help you overcome the roadblocks in efficient RCM. Connect with us today for a free RCM consultation.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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