We don’t have to tell you how many administrative tasks it takes to run a healthcare organization. From private practices to hospitals to health tech companies, teams spend countless hours on vital operational to-do lists.
One of the more time-consuming responsibilities is eligibility checks — verifying a patient’s insurance coverage before an appointment or procedure. It’s one of the first steps in the revenue cycle management (RCM) process and can set the stage for the overall patient-provider encounter.
But here’s the secret: Eligibility checks don’t have to be time-consuming.
What’s more: Optimizing your eligibility check process can also improve patient payments. Let’s dig into how you can make that happen.
What Is an Eligibility Check?
A patient eligibility check involves getting correct patient demographics to verify their insurance coverage for a service or procedure. It’s the first and most important step of the RCM process. Your organization likely does its eligibility checks during patient registration.
Aside from coverage, the insurance verification also looks at the patient’s payment responsibilities, including copays, coinsurance and deductibles.
Verifying insurance before a patient encounter is critical for the health of your revenue cycle. There are two primary benefits:
- It can reduce the likelihood of a claim rejection or denial. Rejections and denials have many downstream effects on your revenue cycle, so it’s essential to have 100% accuracy with your insurance verification.
- It can increase timely patient payments, as patients have an up-front understanding of their responsibility.
How Long Do Eligibility Checks Take?
The manual check process can take as little as five minutes or as much as 15 minutes per check, depending on your staff’s experience and knowledge of the eligibility process.
Your practice can approach eligibility checks in a few different ways. Online tools — such as insurance company websites, directories, and payer portals — provide eligibility and estimate information.
There’s also the option to manually check eligibility via phone, which can be more time-consuming. This process involves calling the insurance provider with the patient’s information and asking questions about their plan’s coverage.
Is There a Way to Improve the Eligibility Check Process?
A faster option is a real-time eligibility tool. These platforms allow your team to instantly verify patient insurance, reducing that 5-to15-minute process to 30 seconds or less. Many real-time eligibility check tools can also integrate into your organization’s existing EHR or PM system, so your staff doesn’t waste time switching between platforms.
All this translates to better resource allocation — your team can spend more time on other essential tasks to help your organization grow.
Let’s create a quick scenario: Your growing behavioral health practice needs to verify insurance for roughly 40 patients a week. Each eligibility check may take five minutes or so to complete, which means your team is spending nearly three-and-a-half hours on eligibility checks every week.
Also, consider that some checks may take much longer — 15 or 20 minutes if your team member needs to call an insurer to verify eligibility or dig around on their portal.
But if your team has a real-time eligibility check tool, they’ll spend less than 30 seconds on each patient check — not five, 10 or 20 minutes. You’ll cut a three-and-a-half-hour process down to less than 20 minutes. And if the tool can do batch checks, you’ll cut down the time further.
Better Eligibility Check Process = Increased Patient Payments
Improving staff resources is a huge advantage to real-time checks. Still, perhaps the most important benefit of an improved eligibility check process is increased patient payments.
Patients are more likely to make timely payments if they understand costs up-front. Increased cost transparency can also boost your overall patient satisfaction — they’re more likely to trust your organization for care if they know you’re not going to surprise them with a high medical bill.
Consider these stats:
- According to a 2018 HIMSS survey, 68% of patients would be likely to return to practice for future care if it provided cost estimates before the appointment or procedure.
- That same survey showed 46% of patients would be willing to pay a larger portion of their bill up-front if they received a cost estimate before treatment.
- A 2020 analysis from the Kaiser Family Foundation (KFF) showed that 67% of U.S. adults worry about surprise medical bills.
No Surprises Act
It’s important to acknowledge that an instant verification tool is another investment for your organization. But the time savings it can provide and the increased patient payments will ultimately improve your bottom line.
Get Real-Time Eligibility Checks and Patient Estimates with Gentem Boost
If you want to improve your insurance verification process and increase patient payments, Gentem Boost is the tool for you. Here’s why:
- It allows your team to send patient estimates instantly via HIPAA-compliant text or email, increasing upfront payments and patient satisfaction.
- You’ll get real-time eligibility checks, helping your team verify insurance and get patient payment estimates in seconds. See how one startup saved 23 hours per FTE using Gentem’s eligibility tool.
- The batch eligibility check allows you to verify insurance for multiple patients at once, saving you more time.
- If you’re unsure about an estimate’s accuracy, you can ask our billing experts to make payer phone calls on your behalf to confirm benefits details.
- You’ll save time and avoid downstream revenue cycle issues by setting automated insurance checks for the week’s appointments. No need to worry about patients making last-minute insurance changes.
- Our platform is easy-to-understand, so your team won’t have to spend extra time deciphering complicated eligibility results.
Increase Revenue & Collection Rates
Gentem’s tech platform and team of billing experts increase practice revenue by an average of 20%.