Revenue cycle management (RCM) starts before you ever see a patient or administer a service. It begins when you commence collecting information. Perhaps the most important piece of information you can collect — the one most relevant to eventual cash flow — involves eligibility verification or the process of confirming a patient’s insurance coverage and determining their financial responsibility.
Unfortunately, traditional manual approaches to eligibility verification are time-consuming and prone to errors, potentially leading to delayed payments and increased denials. It’s why many practices are turning to automated eligibility verification as an early step in improving their RCM approach.
Understanding eligibility
Eligibility verification is about ensuring a patient’s health insurance covers the services they’re seeking. Traditionally, it’s a manual and tedious ordeal, rife with inefficiencies and susceptibilities to error. Administrators must comb through complex paperwork and communications with payers to ascertain a patient’s insurance status.
Problems with conventional verification translate into RCM problems, such as delayed payments, increased denials, and a strain on the revenue cycle as a whole. Moreover, the reliance on phone calls, faxes, and manual data entry is its own bottleneck. Thankfully, automated eligibility verification systems are emerging.
How to automate eligibility verification
The transition to automated eligibility verification involves strategic steps to make a meaningful impact on RCM:
- Software selection: Choosing an appropriate eligibility verification platform requires a comprehensive evaluation of key features and considerations. These might include real-time data access, an intuitive user interface, and compatibility with existing practice management systems.
- Integration: Beyond software selection, the implementation process includes data integration and workflow design. The design of an efficient workflow is pivotal. Eligibility verification should connect directly to other RCM components. Deliberate orchestration optimizes data accuracy, accelerates verification, and minimizes redundancies.
- Adoption: Staff training and change management are crucial for successful adoption. Healthcare practices must foster a culture of adaptability, communicate the benefits of automation, and make staff comfortable with eligibility verification.
True automation of eligibility verification makes it a seamless part of RCM’s initial stages, connecting registration with utilization review and facilitating care with financial accountability in mind.
Benefits of automating eligibility
In the context of the full RCM process, it’s easy to minimize the importance of automating eligibility verification. But practices that prioritize it can reap several key benefits:
- Streamlined workflows: Real-time verification virtually eliminates wait times to expedite the entire verification process. This not only accelerates claims but also minimizes administrative bottlenecks, allowing staff to focus where it matters most — on patient experience.
- Improved accuracy and efficiency: Automation is the antidote to inconsistency. Consistently applying predefined eligibility criteria promotes accurate eligibility checks, eliminating common errors. Beyond accuracy, automation also unlocks faster verification cycles, freeing up staff to concentrate on strategic aspects of RCM.
- Reduced denials and rejections: Automated verification is proactive and can preemptively highlight coverage gaps before they escalate into denials or rejections. A reduction in problematic claims results in a healthier cash flow and financial predictability.
Less time spent navigating the cumbersome process of manually verifying eligibility also puts providers in a position to examine other aspects of their RCM processes.
Eligibility’s role in RCM
As it has the power to do in many other RCM phases, automation is essential in optimizing eligibility verification. Embracing automation not only improves financial outcomes but also enables healthcare practices to focus on delivering quality care to their patients — all with the knowledge of who’s financially responsible. From private insurance to Medicare and Medicaid, eligibility verification demands automation — and automation begets better cash flow down the line.
Learn more about automating eligibility verification with TruBridge.
