How Automated Insurance Verification Streamlines the Revenue Cycle

The healthcare revenue cycle is complex, with multiple touchpoints that require verification of patient insurance coverage. Traditionally, insurance verification has been a manual process - which is time-consuming, prone to errors, and creates administrative burdens for healthcare staff. However, new automated solutions are streamlining this critical revenue cycle component.

This article will explore how automating insurance verification can reduce manual work for healthcare providers' administrative teams. We'll cover:

• The Challenges of Manual Insurance Verification Processes
• Streamlining Verification with Automated Solutions
• Key Benefits of Automation for Providers
• Features to Look for in Automated Verification Tools

The Challenges of Manual Insurance Verification

Verifying patient insurance coverage eligibility and details is essential for the revenue cycle. This process confirms:

• Insurance status
• Type of health plan
• Patient responsibility
• Services covered

Without proper eligibility verification healthcare claims may be denied - delaying or preventing reimbursement.

Manual verification  is prone to the following issues:

Data Entry Errors

Typos can lead to denied claims if names or policy numbers don't match insurance records.

Re-Verification

As insurance details might change during the patients’ stay in the facility, it is important to check if there are any changes to the coverage. Billers can miss important insurance changes when tracking manually.

Difficulty Confirming Complex Details

The most time-consuming verifications involve Medicare and Medicaid. It is challenging to follow up accurately on deductibles, secondary payers, and third-party liability arrangements, but mistakes can leave money on the table.

Limited Visibility

Once verification details are entered or checked, they become "siloed" within individual patient accounts.

The National Healthcare Exchange Service found that the cost of manual eligibility verification is $3.70 per claim, while automated processes only cost $0.74. So, streamlining this workflow presents a major opportunity to reduce administrative costs.

Streamlining Verification with Automated Solutions

Advanced automated insurance verification tools are now integrated directly into many billing and EHR systems.

These technologies tap into payers' electronic eligibility checking services - bypassing manual phone and portal checks. After entering a patient's information just once, staff can automatically verify coverage details on an ongoing basis.

Automated verification solutions check eligibility in real-time during the admission process. Updates are pushed straight into workflows - without any data entry. Coverage tracking feature can send automatic notifications and notify staff of any changes in coverage.

Key capabilities include:

Real-Time Eligibility Checks

The software shows the current eligibility statuses, effective dates, plan types, and more in real-time.

Batch Eligibility Monitoring

Batch eligibility checks allow staff to enter multiple patients at once.

Ongoing Coverage Monitoring

Automated systems run eligibility checks at scheduled intervals to catch coverage changes. Alerts notify staff when re-verification is needed after a change.

Insurance Discovery

Such software can find previously unknown or missed coverage for patients and present additional reimbursement opportunities for the healthcare provider.

Altogether, automation makes the verification process seamless for both patients and staff. Admissions personnel can focus on other administrative tasks while billers reliably submit accurate claims from the first time.

Key Benefits of Automation for Providers

Automating insurance verification offers numerous tangible benefits:

Fewer Claim Denials

85% of claim denials are preventable! With up-to-date eligibility data auto-validated before billing, claim acceptance rates see significant improvements. Denials attributed purely to outdated or incorrect coverage details become virtually non-existent.

Faster Reimbursements

Accurate initial submissions allow clean claims to process faster through payer systems. Without basic data issues holding up payments, practices see reimbursement timelines accelerate.

Lower Administrative Costs

Automation reduces time spent on manual verification steps across scheduling, registration, and billing. As stated in the 2021 CAQH Index, manual verifications require at least 12 minutes, and this time can almost triple if follow-up concerns are considered. This time can be cut by half through automation and thus is a major area where practices can save a lot of money on labor.

Improved Productivity

With verification automated in the background, administrative, admissions processes become faster.

Consistent Verification

Configurable rules standardize eligibility checking protocols across all patients and staff. This prevents missed updates that lead to denied claims.

In total, automation reduces the risk and redo of the manual verification process to the barest minimum. This leads to the benefit of having accurate and timely payment of claims, thus attaining a better revenue cycle.

Features to Look for in Automated Verification Tools

If implementing an automated eligibility solution, key features to look for include:

1. Real-time verification response
2. Direct EHR integration
3. Batch eligibility analysis capability
4. Automated coverage change alerts
5. Role-based visibility settings
6. Scalability across practice locations and providers
7. Top-rated customer support and implementation assistance

Automation Drives Revenue Cycle Performance

Insurance verification is one of the most time-consuming and critical processes within the healthcare revenue cycle. Manual processes lead to denied claims, reimbursement delays, and cost increases due to administrative overhead.

However, automated verification solutions are an opportunity to overcome these problems with the help of simplified coverage checks.

Leading providers are now integrating intelligent verification solutions directly into the core of operations to achieve better reimbursements at a lower cost while providing patients with a clear and satisfactory payment experience.