5 Must-Haves for Eligibility Verification Automation

Oct 24, 2019 | Blog Article

Many organizations still waste hours on the phone verifying patient coverage. And inaccurate websites, as well as frustrating phone prompts, can make these processes last up to an hour or more for a single patient.

But benefits verification doesn’t just fall onto clerical staff — physicians and nurses must also spend time interacting with insurance providers, which takes away valuable time from patient care. 

Time spent on insurance company communications each week is, on average, 3.4 hours for physicians, 20.6 hours for nurses, and 53.1 hours for clerical staff. That’s roughly $68,274 spent each year on insurance interactions per physician. Which comes out to $23–$31B in total each year — a significant chunk of the national health care burden of $3.2 trillion.

Automating this traditionally manual task, however, can reduce costs and denials while also allowing for more face-to-face time with patients. 

While there are many vendors out there that claim their software gets the job done, we believe in getting more bang for your buck. Your software should do more than just function.

That’s why we’ve put together a list of five features you should look for in your eligibility automation solution. 

5 Must-Haves for Eligibility Verification Automation

1. Payer Coverage Insights. Your eligibility solution should automatically retrieve and combine data from both payer portals and electronic eligibility (like EDI 270/271) transactions to present the most complete benefit details available. Your staff don’t have time to spend countless hours searching payer websites or calling insurance companies for correct information. They need up-to-date information, and they need it quickly. 

2. Real-Time Actionable Alerts. While accurate benefit details are important, they’re not enough to truly change the way your staff work. That’s why you need a vendor who gives you an extra measure of protection, alerting your staff to accounts with denial risk and the next best actions required to alleviate that risk before the denial occurs.

3. Self-Pay Coverage Checks. You’re spending enough money as it is. You shouldn’t have to pay yet another external vendor to perform coverage checks for self-pay patients. Instead, check to see if your potential eligibility verification automation vendor is able to verify (both pre and post-service) if patients that identify as self-pay qualify for commercial or Medicaid coverage.

4. Seamless EHR Integration. But what’s the point to all of this if your solution doesn’t work within your current workflow? Your HIS is good at managing patient data, but imagine a supercharged system that can also automatically retrieve a patient’s complete benefit details and give valuable insight into denial risk. We’ve said it before, and we’ll say it again: your software should work harder, so you don’t have to. Why utilize technology if it’s not going to streamline staff processes?

5. Recheck Logic. While we’re on the subject of streamlining processes, make sure your software vendor is able to perform eligibility and benefit rechecks. With eligibility changing more frequently, your eligibility software should automatically recheck benefits as soon as demographic information is updated in your HIS system, or your chance of denial just increased. 

The Wrap Up

The administrative burden of healthcare is huge. And, much to our dismay, that burden isn’t going anywhere anytime soon. But you can offset the stress of the ever-burgeoning healthcare system with automation. Starting with your eligibility processes.

See how providers are increasing their eligibility accuracy by more than 55% with EligibilityPlus™ by Recondo.

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