Are eligibility changes putting you at risk?

May 4, 2017 ABILITY

In the midst of potential changes to the healthcare system it can be easy to forget the importance of the basics like patient eligibility. Checking for changes in patient insurance coverage will always be a top priority, and missing the fine details can leave you in a challenging situation. Fortunately, there are strategies to address this potentially frustrating situation.

Until now, you’ve likely relied on one of two methods to protect yourself from denied claims. First, manual eligibility is an old standby that requires someone in your organization to tediously recheck eligibility for the entire patient census. This can be a major time investment and doesn’t guarantee your protection against changes later in the year. The second method is even less reliable: crossing your fingers. You educate your patients and facilitate a dialogue as a chance to discuss changes, then you simply hope they heard you and follow through if and when a change occurs.

What does this mean for you?

In each of these scenarios you leave it up to chance, risking delayed reimbursement in the event of an insurance change. If a payment is denied, you face an unpleasant choice: surprise the patient with a bill they weren’t expecting, or write off your services altogether. The first option might leave you with a disappointed patient who may seek healthcare services elsewhere in the future. The second leaves you without the money you’re rightfully owed for the care you’ve provided.

A third option: an assist from technology

These issues are common to healthcare providers, but you do have options for successfully addressing them proactively. If you’re torn between spending hours on manual re-validation or doing nothing and hoping for the best, you should know you have a third option. Many facilities use a software application to perform eligibility checks automatically and to rerun checks on a recurring basis. These services often pay for themselves by preventing claim denials, and can be used to:

-Do a batch check of your patients at the start of the year

-Alert you when a patient’s coverage changes or they become non-eligible.

-Speed up verification with easy, accurate, real-time checks of insurance and benefits

-Check eligibility before providing service

Having a system for eligibility verification can prove beneficial in other ways. It can help ensure billing of the correct payer the first time and ensure you receive prompt reimbursement. These two items alone can help improve cash flow, reduce write-offs, and reduce patient bad debt, all making sure that you receive due payment for services provided and that your patients aren’t stuck with a surprise bill. With the alternative being the prospect of insurance change surprises, you’ll likely find it helpful to know you have a dedicated and comprehensive resource working for you.

ABILITY Network applications can help you avoid eligibility issues. For additional information, contact us today. You can also watch this short video “3 Ways to Avoid Patient Coverage Surprises” for additional strategies on avoiding eligibility issues, or visit the Open Enrollment section of our Resource Center.

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