4 Advantages of Automated Benefits Verification in Medical Billing

In 2023, insurers offering qualified health plans on HealthCare.gov denied approximately 20% of in-network claims, with denial rates varying significantly by insurer and state, ranging from 1% to 54%. 

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This high rate of claim denials underscores the critical need for robust benefits verification processes to mitigate financial losses and enhance operational efficiency.

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Eligibility and benefits verification are critical for healthcare providers to assess a patient’s insurance coverage before providing medical services. 

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This article explains benefits verification in medical billing and how it can aid medical professionals and patients in eliminating financial challenges and simplifying the reimbursement process. 

What is Benefits Verification?

Benefits verification in medical billing refers to the process of evaluating a patient’s insurance coverage to determine which medical services are covered and which are not. 

This enables medical practitioners to improve their operational efficiency, minimize administrative burdens, and streamline their revenue cycle management. 

Benefit Verification in Medical Billing: 4 Advantages

Let’s explore some of the must-know advantages of benefits verification in medical billing and why it is an integral part of the entire process. 

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1. Error-free Revenue Cycle Management

According to healthcare professionals, approximately 80% of medical bills contain errors. One of the biggest advantages of benefit verification in medical billing is that it offers medical professionals a clear view of a patient’s financial responsibilities, such as deductibles, copayments, and coverage limits. 

Since the medical staff has access to real-time data, it allows them to verify the claims and create error-free bills, improving patient satisfaction and experience and laying a solid foundation for seamless revenue cycle management. 

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2. Lower Claim Denials

Do you know that incomplete or inaccurate insurance data is one of the top reasons for claim denials, leading to delayed treatment or at times, even loss of revenue for healthcare providers?  

‍Data suggests that 27% of errors linked with denials emerge from the registration eligibility workflow.

Benefits verification in medical billing plays a key role in spotting inaccuracies in a patient’s insurance coverage, reducing claim rejections at an early stage, and empowering medical professionals to monitor reimbursements. 

3. Boosts Operational Efficiency

Conventionally, healthcare providers inspected insurance claims manually, which resulted in lengthy reimbursement cycles, and significant administrative burden. Healthcare providers had to inspect complex insurance policies and rely on manual data entry systems to complete benefits verification. 

‍Plus, 84% of hospital organizations stated that the cost of complying with insurer policies is increasing.

However, the arrival of automated eligibility tools has transformed the vetting process, allowing healthcare providers to access a patient’s insurance coverage spread across various providers. 

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4. Better Patient Experience

Patients with multiple insurance coverages can get confused and distressed while picking the right policy for a particular case. 

However, automated benefits verification in medical billing provided them with a 360-degree view of their coverage plans with different providers, allowing them to make informed decisions and eliminate the possibility of unexpected bills. 

This ensures patients get upfront clarity and can focus on receiving the best medical services instead of scrambling to find the best coverage for them. 

3 Best Practices for Effective Benefits Verification in Medical Billing

Healthcare providers must understand that offering the best medical services may not cut it anymore – the focus should also be on providing a seamless patient experience along with the best services. 

Here are some best practices for benefits verification every healthcare provider must consider:

1. Gather Relevant and Useful Patient Information

It is crucial for the front-office staff to gather relevant, accurate, and the latest patient information such as identification documents, policy details, and insurance cards before verifying the claim. 

Here, the onus is on the service providers to encourage all patients to enter all the relevant details to prevent delays and errors. 

2. Integrate Automation Into the Process

If you haven’t integrated automation into your processes, you are losing out, burdening your staff with a lot of paperwork and cumbersome activities. 

Today, technologically advanced tools powered by artificial intelligence (AI) and data analytics allow healthcare providers to streamline benefits verification and minimize manual errors. The result – easy access to data, increased productivity, and real-time eligibility checks. 

3. Create a Standard Process

While every case is unique, healthcare service providers must focus on creating a standard operating procedure (SOP) for different types of benefits claims. 

Right from benefits verification to reimbursement and everything in between, healthcare practitioners must ensure consistency and minimize variations to reduce friction and improve execution. 

Key Steps Involved in Benefits Verification in Medical Billing

Now, let’s explore how benefits verification in medical billing works.

1. Gather Patient Data

The first step is to collect all the key information from the patients to verify their eligibility. 

Here’s what healthcare providers need to know before they can proceed further:

• Member Name
• Date of birth
• Insurance provider
• Policy number
• Plan type
• Subscriber name
• Relationship to subscriber
• Policy effective date

This data should be gathered in advance (around 48 hours before the first appointment), giving medical professionals enough time to verify and complete the entire process without any last-minute hiccups. 

2. Confirm the Details

Once all the data is collected from the patients, healthcare service providers must verify it by evaluating the documents and contacting the insurer. It is a good idea to check whether the healthcare service is within the insurer’s network. 

This is where they need to check and carefully review the special causes, pre-authorization requirements, deductibles, and copayments. 

3. Verification Results

Once the previous steps are complete, it is now time to document all the data to monitor changes (if any) to the insurance coverage and make informed billing decisions. 

The arrival of automated benefits verification systems lifts a significant amount of load, allowing the admin staff to focus on other important tasks. 

Once the verification is complete, it is crucial to communicate with patients and let them know the total amount – break it down into upfront costs, out-of-pocket expenses, and how much they need to pay once the treatment is complete. 

Parting Notes

Benefits verification in medical billing is undoubtedly one of the most important steps to streamline revenue cycle management and make it as transparent as possible for patients. The end goal is to raise productivity levels, provide the best treatment plans based on insurance coverage, and, most importantly, maximize claim rates. 

Healthcare providers must consider replacing conventional verification and reimbursement techniques with automated and data-driven systems to improve patient experiences and remain competitive in today’s dynamic healthcare ecosystem. 

If you are a healthcare service provider looking to transform your revenue-cycle management processes, explore our pre-service solutions. 

To learn more, contact us today! 

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