The healthcare revenue cycle contains multiple potential pinch points for the parties involved: patients don’t enjoy dealing with insurance companies and have trouble understanding their benefits, and they especially hate being responsible for surprise medical costs that aren’t covered by their insurance plan. Healthcare providers compete in a challenging landscape and struggle with managing overhead and minimizing bad debt due to outstanding account balances. Fortunately, software is available to minimize the pain of these pinch points. When practices automate insurance eligibility verification, they save time and money. When patients then visit these healthcare organizations, they will know what to expect instead of receiving a surprise down the road, and the patient experience is improved.
A recent study published in the Journal of the American Medical Association cites administrative costs as one of the main contributors to increased healthcare spending in the United States compared to other high-income nations.
The study acknowledges the unique administrative challenges of juggling multiple payers with differing requirements and benefits, and identifies administrative overhead as a target for cost savings. The administrative task of verifying insurance coverage can be a labor-intensive and expensive endeavor, but advances in software development give healthcare practices the opportunity to significantly reduce this burden.
Automated insurance eligibility verification can potentially save thousands of staff hours spent making phone calls to insurance providers. The payer information is also available through this software around the clock, thus alleviating the challenges associated with accessing information outside business hours or across time zones. Batch requests can be processed overnight based on upcoming appointments booked in the schedule. This software also offers flexibility for individual insurance eligibility verification, which is handy for same-day or walk-in appointments. This frees up administrative staff for other duties, such as providing direct guidance to patients and focusing on improving other aspects of practice and revenue cycle management.
Verifying insurance eligibility before services are provided to patients is good for business. This allows office staff to have advance discussions with the patient about payment responsibility and options. Staff can then collect copayments in full at the time of service and ensure a plan is in place for self-pay patients, such as retaining a card on file for automated payments.
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No one wants to be in the position of receiving an unexpected bill or being unable to pay for health services. When insurance questions are resolved before services are provided, patients will know what to expect and will be able to plan accordingly, such as by reevaluating their budgets, exploring alternative payment methods, or investigating options for charitable assistance.
The healthcare landscape is complex, and it is challenging for all parties involved. With incremental adjustments to make administrative tasks more efficient, practices can control costs and provide quality care to the patients whose health depends on being able to afford it.