Claim denials: The most painful, cringe-worthy revenue headaches for physician practices across the country.
Why? (We’re picturing you shaking your head knowingly.) Of course, because far too many denials affecting your cash flow can be drilled down to clear and avoidable causes. For instance, …
You weren’t aware that the patient was ineligible for the services you already provided, and now you’re stuck with a denied claim from their insurance company.
Your front office staff is overworked. A ball is dropped in collecting the patient’s information, including current healthcare coverage, resulting in rejected claims due to eligibility.
You’re not operating with a huge budget here – and you don’t have the resources to support checking and rechecking multiple existing patients for changes in coverage … which inevitably change at some point in the reimbursement cycle, causing (you guessed it!) additional denials.
What’s worse, the frustration of eligibility-related denials and rejections for small and independent physician practices is likely at an all-time high – especially in a year that has so far been devoted to managing a global pandemic and avalanche of changes related to telehealth, Medicare reimbursement and upended staffing resources.
Don’t despair! Here’s the good news: Registration, eligibility and pre-service challenges are, in fact, some of your best chances to improve revenue.
That’s because eligibility errors create more reimbursement challenges than any other claim issue.
When you stop the leaks – or implement proactive measures to avoid them – you see an immediate benefit to your bottom line.
I don’t have the budget to automate my billing efforts – so what now?
First, know you’re not alone. Just a few years ago, HIMSS Analytics reported 31% of providers still used manual claims denial management. Based on their findings, researchers at HIMSS Analytics recommend that providers should consider a more automated approach to claims denial management, especially as value-based care models begin to overshadow traditional fee-for-service structures.
Many small and independent practices rely heavily on front-office staff for billing and medical verification. But consider how much time and resources are eaten up with this model – and how badly it that could affect your overall customer service.
If your practice is still checking eligibility manually or if verification hinders your billing efforts, implementing eligibility technology will make dramatic differences in the team’s time, in mitigating eligibility-related denials and your bottom line.
Determining your process: What to keep in mind
Choosing an eligibility verification system eliminates a costly manual process. More advanced systems will automate the process of retrieving data directly from the payer websites, significantly enhancing the data you receive in your eligibility reporting. By capturing and comparing even more personal patient data and coverage information, enhanced eligibility has the potential to exponentially improve workflow and output.
Tracking patient coverage changes requires a process to regularly check eligibility. Chances are your practice has regular patients – which means performing monthly verification is crucial to better reimbursement rates. Leveraging an eligibility technology vendor with automated change reporting capabilities will eliminate the hassle of manually sifting through heaps of patient data looking for changes. And, a vendor with enhanced eligibility verification will report only those patients who show coverage changes.
Adding an automated insurance discovery tool to your process boosts the chances of securing payment for care that may otherwise go uncompensated. Insurance discovery lets your front office team find patient eligibility for government and commercial coverage that may be missing or unknown during patient registration.
The payoff of a solid eligibility process is positive cash flow, fewer eligibility-related denials and rejections and a more efficient staff. Using a vendor for enhanced eligibility improves workflow automation and reduces labor costs and days in A/R.
Maximizing reimbursement is akin to maximizing revenue
For over two decades, providers have trusted eSolutions to offer all the functionality they need to maximize reimbursement – plus, additional features like enhanced eligibility verification that further eliminate manual work and lost revenue. eSolutions has the fastest eligibility response time among competitors and the lowest eligibility error rate – that means you will get a response you can trust.
Whether you need to check eligibility and coverage on your Medicare, Medicaid or commercial payer patient, we return the most comprehensive, real-time patient data in seconds.
eSolutions also takes it a step further by connecting directly to payer websites where exclusive technology electronically retrieves additional comprehensive patient data needed to secure reimbursement. This means you get complete benefit details upfront and can check coverage within seconds, reducing eligibility-related denials.