How real-time eligibility verification can enhance practice efficiency

Your Medical Practices Can Avoid Lost Revenue from Front Office Inefficiencies

Health care coverage in the United States is in a precarious spot. That’s why medical practices must do whatever they can to ensure they’re taking full advantage of all available revenue opportunities.

One of the best ways to do that is with software featuring real-time medical eligibility verification, found as part of an EMR/EHR software suite, which can assist with a many of the problems associated with patient coverage. Too often, practices rely heavily on front office staff as the first line of defense for billing and medical verification but do not give them the best tools available for the job. This leaves front staff with a more complicated billing process, which can affect everything from revenue generation to customer service.

Consider that an average medical practice submits around 83 claims per day, and yet only slightly more than half of accounts receivable are collected after a month's rel="noopener noreferrer" time. According to the Center for Medicare & Medicaid Services (CMS), that results in issues such as two-thirds of physician practice revenue lost due to billing leakage and 30% of claims being denied or ignored on first submission. In fact, it's estimated that doctors in the U.S. lose up to $125 billion a year because of poor billing practices.

Whenever a patient initially makes contact with a medical practice, for instance, that should automatically trigger the start of the billing process and insurance eligibility verification. Front office staff should immediately begin collecting the patient's information, including demographics and current healthcare coverage, for billing purposes. Unfortunately, whether it's due to overworked staff or poor organization, this doesn't always happen, which can result in rejected claims due to eligibility.

Billing trouble is just one of issues that can impact a medical practice's revenue stream, of course, especially when rel="noopener noreferrer" it comes to front desk staff. In 2016, the Journal of Medical Practice Management found that 96% of patient complaints are related to customer service, while only 4% correspond to quality of care. With online reviews of medical practices now commonplace, and many potential patients researching doctors beforehand, it's worth noting a dysfunctional front office can gain a bad reputation quickly, forcing current patients to switch doctors and new ones to stay far away.

A front office staff that isn't providing quality customer cars while also slipping in its billing duties is going to have a detrimental effect on a practice. Getting staffing in order is one part of that equation, but another is adding crucial technology such as medical eligibility verification software.

Medical eligibility verification simplifies the front-office billing process by providing real-time decisions on medical eligibility and benefits, insurance verification

(including Medicaid and many other types of coverage), and handling co-pay, co-insurance and deductible data. Since medical eligibility verification software allows staff to instantly check medical eligibility, it greatly reduces scenarios such as a patient's plan expiring before an appointment or a carrier unexpectedly not covering a certain procedure.

In the case of MediTouch's Medical Eligibility Verification, it also allows staff to easily build a patient chart from an eligibility check, which eliminates errors associated with manual entry of registration information, for instance, and ensures accuracy of patient data in the billing system. Plus, when this medical eligibility verification is implemented at the time of initial appointment scheduling, it'll help speed-up the check-in process for patients.

Once these methods for medical eligibility verification are in place, front office staff will become free from many of the daily, headache-inducing burdens of billing. This can lead to a more efficient front office, which equals faster payments and better overall customer experiences— both of which will help positively impact a medical practice's bottom line.