Top 5 Overlooked Methods Proven to Increase the Efficiency, Accuracy of Eligibility Verifications

Changing policies.New forms.Added steps to the process. Pick any of these, yet alone the longer laundry list of the issues associated with eligibility reporting, and it’s understandable why many practices struggle with staying current and optimizing the tools available to them. I correlate it to taxes – tax accountants are paid to stay current with everything and thus maximize the return to each customer.

The same can be said for physician eligibility verification. There are specialists you can outsource to, ultimately optimizing the process for the practice. For those who maintain the eligibility in-house, don’t overlook proven methods. Abide by these tips to help assure you get it right every time and lower the risk of insurance claim issues and maximizeyour revenue.

Top 5 Overlooked Methods Proven to Increase the Efficiency, Accuracy of Eligibility Verifications

  • Verifying existing and new patient eligibility each and every visit: New and existing patients should have their eligibility verified Every. Single.Visit. Quite often, practices do not re-verify existing patient information because it’s assumed their qualifying information will remain the same. Not the case. Change of employment, change of insurance coverage or company, services and maximum benefits met can alter eligibility.
  • Assuring accurate and complete patient information: Mistakes can be made in data entry when someone is trying to be speedy for the sake of efficiency. Even the slightest inaccuracy in patient information submitted for eligibility verification can cause a domino effect of issues. Triple checking the accuracy of your eligibility entries will seem like it wastes time, but it will save time in the long run saving practice managers from unnecessary insurance company calls and follow-up. Be sure that you have the patient’s name spelling, birthdate, policy number and relationship to the insured correct (just to name a few).
  • Choosing wisely when depending on clearinghouses: While clearinghouses can offer quick access to eligibility information, they most times do not offer all necessary information to accurately verify a patient’s eligibility. More often than not, a call made to a representative at an insurance company is necessary to gather all needed eligibility information.
  • Knowing exactly what a patient owes before they even arrive at the appointment: You should know and be ready to advise a patient on the exact amount they owe for a visit before they even arrive at the office. This will save money and time for a practice, freeing staff from lengthy billing processes, accounts receivable follow-up and even enlisting the help of credit bureaus to collect on balances owed.
  • Having a verifications template specific to the office’s/physician’s specialty. Defined and specific questions for coverage pertaining to your specialty of practice will be a major help. Not all specialties are the same, nor are they treated the same by insurance company requirements and coverage for claims and billing.


As we said, it’s practically impossible for all practice operations to run smoothly. There are inevitable pitfalls and areas prone to issues. It is important to establish a defined workflow plan that includes mix of technology and outsourcing if needed to achieve consistency and accountability.

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