4 Ways Real-Time Eligibility Impacts Your Workflow
What is Eligibility in Healthcare?
Real-time eligibility can positively or negatively impact your practice depending on how you handle it. Mishandling the steps could lead to angry patients and unpaid claims. On the other hand, if you play your cards right, your practice can benefit from it big time. Reimbursements take time. That's why you need to focus on the accuracy of your practice's real-time eligibility process.
This blog post will highlight four ways real-time eligibility impacts your workflow. We'll cover its definition and provide interesting information regarding its advantages. So, if you're ready, let's begin our discussion.
What is a Real-Time Eligibility Check?
Real-time eligibility refers to verifying a patient's insurance coverage electronically. In addition, it allows insurance providers and medical practitioners quick access to relevant information in claims processing.
Impacts of Eligibility Verification on Medical Billing
Here are the top 4 ways real-time eligibility affects your practice's overall workflow.
Optimizes Patient Experience and Satisfaction
Processing patient deductibles under constant plan changes consumes time and effort. Verifying your patients' coverage and benefits becomes taxing and exhausting. Without reliable real-time eligibility processing, these tasks can become overwhelming.
You and your medical staff's productivity will suffer. In addition, long processing times will affect patient experience and satisfaction. Utilizing the real-time eligibility process can reduce the risks of delays and denials. It also doubles your productivity and increases patient satisfaction. As you can see, it positively impacts your practice if done correctly.
Gets You Paid Faster
With the ability to reduce delays and denials, you can get paid faster. Studies say the typical causes of claim delays and denials come from incorrect handling or lack of real-time eligibility processes. With this approach, you can include only relevant information needed in the payment process.
Moreover, data collection will be more accurate. You can avoid recording inaccurate, incorrect, or missing data by including only the information that matters. Do this right, and you'll get paid faster.
Optimized Collections
As the phrase implies, real-time eligibility produces real-time results. You can verify your patient's eligibility coverage as early as the initial appointment scheduling and registration. The process eliminates uncollected revenue quickly.
The process optimizes your collections whether patients update their registration information, mode of payment, or insurance verification. In addition, it eliminates the risks of future income loss. As a result, your cash flow is significantly boosted by gathering only the correct payment and insurance information.
Spend More Time with Your Patients
Providing your patients with the best treatment is perhaps the most significant impact on your practice. After all, the life and blood of your medical practice depend on your capability to provide quality healthcare services.
Dealing with eligibility issues is time-consuming. Imagine spending countless hours fixing eligibility issues instead of patient care. It risks losing revenue and affects your treatment methods' efficiency.
Medical Billing Eligibility: How it Works
Real-time eligibility works by
- Gathering patients' insurance status and information before the appointment takes place.
- Asks for updates from the patients in case copay applies.
- Verification of insurance updates to ensure the member's account is recorded for an expedited check-in process.
- Requests the patients to update their primary care physician and coordinate covered benefits.
The information below should be provided for each patient:
- Patient member number
- Patient name
- Patient gender
- Patient member number
- Patient gender
- Patient date of birth
- Subscriber name
- Patient's relationship with the subscriber
- Plan type coverage date (effective date)
- Group name and number
When to Check Patient Eligibility
It should be a given when eligibility should be checked. Healthcare providers should always be proactive. The ideal time to verify the eligibility coverage is before the appointment occurs. Typically around 48 hours before the initial visit. As an alternative, the insurance eligibility can also be checked during check-in.
Additional Information
The front-desk personnel or the remote medical staff should always ask for recent updates regarding the insurance from the last visit.
Best Practices Tips
Below is a list of the best practices you can follow to improve your real-time eligibility process.
- Check for inactive plans
- Flag inactive accounts
- Check for primary, secondary, and tertiary insurance.
- Remind patients with multiple insurance plans to update their COB. (By default, Medicaid is the payer of last resort).
- Verify if the insurance coverage is traditional for Medicaid members (65 or older)
- Always verify and confirm the services under the member's policy. Moreover, check if a referral or prior authorization is required.
- Verify the captured referrals and authorizations are approved. It should be linked to the appropriate visits.
- Check and specify the listed insurance limit.
- Identify if a copay, deductible, or coinsurance should be collected.
Final Thoughts
The secret to getting paid faster with fewer errors that may lead to delays and denials is the proper use of a real-time eligibility process. Additionally, you can focus on treating your patients and spending more time with them. Look for a team who knows their medical billing and coding processes well.
Partner with DrCatalyst
DrCatalyst is the home of world-class virtual medical professionals that can help you with the real-time eligibility process. Our team offers a complete revenue cycle management service to help you get paid faster. In addition, we create a comprehensive analytical report regarding your practice's status to help you adjust and make room for improvements.
Give us a
ring today and schedule a free consult. We hope to hear from you soon!
