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Best Practices for E-Eligibility

By: Nextech | December 29th, 2014

Best Practices for E-Eligibility Blog Feature

As patients assume increasing responsibility for personal healthcare costs, determining eligibility has become essential to patient satisfaction—and to protecting the practice’s revenue cycle. When patients who are accustomed to incurring only minor co-pays receive bills that are far greater than expected, those who can’t pay or resist payment can represent very difficult collections. This can be especially problematic for specialty practices that have different co-pays from primary care providers or services that may require referral or preauthorization for coverage.

A clearinghouse with an electronic eligibility (e-eligibility) service can minimize the need for patient collections. By automating insurance verification for immediate and accurate identification of coverage—eliminating a time-consuming task for staff—e-eligibility can quickly determine precise patient responsibility before services are rendered, enabling up-front collections. In addition to eliminating potential payment delays and revenue loss associated with post-care patient billing, e-eligibility helps avoid claim rejections due to eligibility verification errors.

Not all e-eligibility services are alike, however. For the best results, the service should offer a very large network of payers to ensure accurate electronic information delivery from all payers to whom a practice will submit claims. It’s also advantageous for the service to bill seamlessly from the practice management system for revenue cycle coordination, including monitoring for correct payer reimbursements. It’s important for practices to select an e-eligibility partner that can truly help to streamline all front-office operations.

Securing an effective e-eligibility service is an important step, but not the only step, toward thorough eligibility protection. Specialty providers should adopt best practices to complement e-eligibility, including:                                

  • Check eligibility before every appointment. A recent physician study found that while 79 percent of practices check eligibility, only 24 percent do it with every patient visit. Coverage often changes, and frequent e-eligibility checks make it easy to have the latest information.
  • Collect patient payments at check-in. In addition to being easier than collecting later, the up-front collection of copayments, deductibles and coinsurance eliminates the time and cost of sending statements. In some cases, patients may even prefer to know their share of payment when making appointments so they can be prepared when they arrive.
  • Consider offering payment program options. An installment plan may be more manageable for some patients, and can assist in patient retention.

By implementing an e-eligibility solution and following best practices, specialists can improve patient satisfaction and ensure their financial stability. To further automate and streamline the revenue cycle, consider an e-eligibility partner who also provides e-remittance, which can reduce claim errors and speed payment receipt—a topic to be covered later in this space.