7 Benefits of Centralized Insurance Eligibility Verification

Simone Arms

Verifying patients’ insurance coverage is more important than ever under the Affordable Care Act. Clinics and hospitals are serving more people who have insurance for the first time or who recently switched plans. Verification of eligibility and benefits ahead of time affects the bottom line, by easing collection of patients’ share of costs while they’re in the office.

Centralized eligibility verification has many advantages compared to verifying insurance as patients check in:

  1. Having specific staff dedicated to eligibility gives your business a better understanding of the benefits of the different plans and what your different payers are looking for in a claim.
  2. With a centralized staff managing the pre-arrival workflow, you know who to go to when working through denials related to eligibility.
  3. Proactively handling issues. Staffers focused on eligibility verification are able to see the big picture and spot troubling trends. If the same issue keeps coming up with a certain payer, it can be identified and resolved once and for all. Front-desk staff are stretched too thin for that type of follow-up.
  4. Smoother patient check-in. Freeing front-desk from eligibility verification means they can focus on the patient in front of them or on the phone, rather than multi-tasking.
  5. Reduced denials. Systematic verification helps avoid claims denials related to eligibility.
  6. Higher upfront collections. Centralized eligibility verification gives you a better understanding of your patients’ benefits and cost responsibility. This helps collect accurate amounts at the point of service. Having a pre-arrival process in place also gives you time to let patients know their estimated costs ahead of time, so they come prepared to pay deposits and copays.
  7. More automation. Many systems can be set up to flag patient records that need a closer look, letting your staff ignore the clean verifications. You focus on what needs work – inactive insurance, discrepancies in patient demographics or coordination of benefits.

Have you centralized your eligibility verification? How’s it going? For ideas on measuring success, see my post on Key Performance Indicators.

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