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The importance of patient insurance eligibility verification

May 26, 2023

eMEDIX Reimbursement Solutions allows providers to process claims in real time, delivering one of the fastest turnaround times in the industry.

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Is your practice still doing manual patient insurance eligibility verification? Do you know how much time and money it is costing you?

According to an MGMA analysis, the average practice spends approximately 12.64 minutes manually verifying a single patient’s insurance eligibility. To put this in perspective: if you were to manually check eligibility for every patient you see in a day, and you see 40 patients, you’d have to spend 8.4 hours just checking eligibility. That’s a full day’s work for one of your employees!

In terms of financial cost, CompuGroup Medical estimates that practices doing manual eligibility checks lose the average visit cost of two patients per day. More concretely, a CAQH study found that performing just 1,250 manual eligibility checks a year—only a few per business day—costs practices an average of $6,000.

Clearly, verifying eligibility manually is cumbersome and costly for your practice and staff. That’s why it’s time to make the switch to electronic patient eligibility verification.

Consider these benefits to your practice should you go electronic:

Point-of-service collections

These days, more and more patients owe a co-pay at the point of service. Also, many consumer-driven health plans specify co-insurance rates and out-of-pocket amounts, which add up to patients paying for a portion of the services your practice provides.

An understanding of your patients’ co-pay amounts, co-insurance, deductibles, and out-of-pockets allows your office to be assertive in collecting patient balances at the point of care, rather than relying on sending patient statements after the fact.

Improved claim acceptance rates with insurance eligibility verification

When insurance information is correct early on, the claim is less likely to be rejected later. Checking eligibility up front improves your first-pass acceptance rates and decreases your days in A/R, which amounts to being paid sooner for your services.

eMEDIX Reimbursement Solutions allows providers to process claims in real time, delivering one of the fastest turnaround times in the industry.

On top of that, your chances of collecting outstanding patient balances goes down with each passing day, so the sooner you can collect from their insurance and bill them for their balance, the more likely it is you’ll be paid.

Finally, you won’t be spending time and effort (and money) resubmitting rejections.

Visibility and patient satisfaction

In addition to the numerous financial benefits, up-front patient eligibility verification allows for greater visibility between you and your patients. Armed with the information they need, your staff is capable of educating your patients ahead of time on the billing process with their insurance plan and what, potentially, they will owe you for the visit. The result is happier patients and fewer contested bills.

There are many benefits to checking insurance eligibility pre-service, but with the costs outlined above, it is easy to understand why many practices are not able to do so for every patient they see. By making the switch to an electronic eligibility verification tool, you can verify patient eligibility for every patient you see, and provide your staff with details of patient benefits in mere seconds. In addition, these solutions operate at a fraction of the cost, usually less than a dollar per transaction.

The result? Your practice can spare the time and effort to verify eligibility up-front for all of your patients, and you can save money doing it. The same CAQH study mentioned above estimates that a practice doing electronic eligibility spends only about $1,000 for the same number of transactions.

That's one-sixth the cost!

To learn more about how electronic patient eligibility verification can help your practice, contact us and ask about eMEDIX Reimbursement Solutions.

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