KPIs for Insurance Eligibility Verification

Simone Arms

There are many benefits to centralized eligibility verification, as I described in my previous post.  Identifying key performance indicators (KPIs) ahead of time will help you set up the system that’s right for your practice. You’ll also be better able to measure the success of your project.

We measure these KPIs when we help healthcare systems optimize their business processes:

% Verified in advance. Less than 10% of your appointments should be verified with the patient standing at the front desk. Our best-performing customers verify insurance for 95% of patients before their scheduled appointment – usually three to four days ahead of time.

Utilization. Of the insurers in your system, how many are set up for electronic (rather than manual) verification? Aim for at least 90%. Our best performers reach 95%.

Denials related to eligibility. Target 1%, both by dollar amount and by number of patients. Our top performers are at 0.25%.

Automation. Adding insurer information to existing patient records automatically is a huge time-saver. We work with our customers to set business rules that flag which patients need follow-up, and which data from insurers can safely be added to patient records. For patients with active insurance, our ‘auto-file’ target is 85%. Our best-performing customers hit 95%. For all responses from insurers (both active and non-active patients) the baseline is 50%, with a stretch goal of 65% across the enterprise.

What KPIs are you using to track your success? Are you hitting the mark?


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