Why Reducing Denials and Rejections Matters More Than Clean Claim Rates
In the world of healthcare revenue cycle management, you often hear terms like clean claim rate, claim denial rate and claim rejection rate. While...
In the healthcare industry, accurate insurance verification is crucial for patient care and overall revenue. Despite its importance, many healthcare providers are still prone to common errors during the verification process.
Accurate insurance eligibility helps to ensure that patients receive the care they need without unexpected financial burdens. It also better positions healthcare providers to be reimbursed for their services. Failing to verify insurance correctly can lead to claim denials, delayed payments and dissatisfied patients, all of which affect the overall patient experience.
By identifying and addressing these errors with some best practices, healthcare organizations can significantly improve operational efficiency, increase revenue and reduce denials.
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1. Not Checking Coverage Changes
One frequent error is failing to check for changes in a patient's insurance coverage. Insurance policies can change due to various reasons, such as employment status, plan updates or annual renewals.
When providers don’t have access to the most up-to-date patient data, it can result in eligibility verification errors and create extra work for staff, all of which can stall the claims process and result in delayed reimbursements or payments.
2. Incorrect Patient Information
Simple patient information mistakes like typos in names, wrong birthdates or incorrect policy numbers often come from miscommunications or oversight during data entry.
Even small errors can lead to claim rejections, causing delays in payments and extra admin work. In fact, 50% of claim denials are due to incorrect billing information acquired on the front end, non-covered charges for care and lack of authorizations.
These hiccups slow down the billing process and can reduce patient satisfaction and trust in the healthcare system. So, it's important to double-check and verify all info before submitting to avoid these issues.
3. Overlooking Benefit Details
Overlooking important benefit details, such as deductibles, copayments and coverage limits, can result in unexpected out-of-pocket costs for patients and denied claims for providers. It's essential to understand the specifics of each patient's insurance plan to avoid these issues.
Best Practices for Improving Insurance Verification
Despite these errors, implementing the following best practices for insurance verification can help providers streamline processes, ensure more accurate billing, save staff time and improve the healthcare patient experience.
1. Use Reliable Verification Tools
Investing in electronic insurance verification tools can help providers screen patients for coverage before receiving care. As a result, providers can quickly understand who is responsible for payment, help teams submit cleaner claims and eliminate unnecessary work.
The 2023 CAQH Index Report found that medical providers can save an average of 16 minutes per transaction by verifying insurance eligibility electronically.
With the right tools, healthcare organizations can:
- Identify ineligible patients for review before their visit, which can lead to higher point-of-service collections and reduced claim denials
- Simplify eligibility verification by presenting the data in a user-friendly format for staff
- Proactively manage self-pay patients with real-time financial counseling
2. Train Staff
Regular training for staff involved in the insurance verification process is crucial. Ensuring they are knowledgeable about the latest insurance policies, verification techniques and tools in place as well as common pitfalls can minimize errors and improve efficiency.
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3. Create a Verification Checklist
To help standardize the process and ensure all necessary steps are followed and information is captured correctly during the insurance eligibility process, a checklist can be very valuable.
The checklist should include:
- Insurance name, phone number and claims address
- Insurance ID and group number
- Name of insured, as it isn’t always the patient
- Relationship of the insured to the patient
- Effective and end dates of the policy
- Other details, including whether the organization participates with the plan, if a prior authorization is necessary for the service and copay and deductible amounts
4. Conduct Regular Audits
Regularly checking the insurance verification process is crucial for spotting improvement opportunities and staying compliant with best practices. These audits should check the accuracy of patient information, evaluate how well verification tools are working, and ensure the verification checklist is being followed.
For more detailed guidance on how to transform your insurance verification process to achieve seamless revenue optimization, click here.
