The healthcare landscape has a very complex insurance structure that could be confusing not just for Hospitals and Practices but for patients as well. Most patients are oblivious of the insurance process as it involves patient responsibilities and other options.

Patients are unaware of these insurance terminologies like copays, deductibles, coinsurance, out-of-pocket expenses among many others, which play an important role in deciding the individual responsibilities, insurance coverage and other significant processes involved in medical billing services.

Patients’ lack of understanding of these processes could be a major hindrance to having transparent communications around the billing processes. Many a times, they are confused over the huge out-of-pocket expenses that they incur, despite choosing a low-cost insurance premium plan. They may feel shortchanged over denied claims before realizing the fact that they wouldn’t have met the deductibles

Research indicates that most of the claim denials are a result of poor patient communication and information including, incorrect forms, incomplete medical dossiers, expired insurance cover, missing claim forms, lack of pre-certification among many others. In this scenario, it is essential that healthcare organization place immense focus on effective eligibility verification process to improve the revenue cycle performance.

To achieve success an effective medical billing process should include the below steps.

1. Patient Scheduling

Patient scheduling is one of the primary steps involved in patient management. Leveraging the capabilities of automated appointment reminder software and patient scheduling systems can help streamline the entire process and facilitate a seamless patient journey. Scheduling reminder software is well-equipped with next-gen features including waiting list management, phone text follow-ups, automated rescheduling of canceled appointments and others.

2. Patient Enrolment

Patient demographic information serves as important data for Hospitals and Practices. It is essential that patient enrolment captures all the necessary information so that form management is simplified in the later stages

3. Eligibility Verification

Eligibility verification is one of the medical billing processes that is most often overlooked and not given the needed attention. A well-designed process can simplify healthcare experiences by preventing claim denials, improving patient engagement and loyalty, and streamlining workflows.

4. Pre-authorization

Prior authorization is one of the essential steps that ensures a seamless workflow and smooth functioning of the revenue cycle process. It is best to get the pre-authorization from the payer to prevent confusions at later stages. Read more on Prior Authorization here.

5. Management of Patient Contacts

Contact patients for any additional information and document them in a structured manner. Documenting patient contacts allows Hospitals and Practices to have a comprehensive record of patients’ vital healthcare information, so the key stakeholders can access patient records as and when needed.

6. Update Billing

Document and update all the relevant patient details including the coverage, medical history, allergies and other critical details in the medical billing software. Medical billing platforms automate many of the complex and repetitive manual tasks allowing the admin staff to singlemindedly focus on higher priority tasks in hand.

Maximizing the Medical Billing Services

Here’s a simple five-step process to maximize the Medical billing process through eligibility verification.

1. Streamlining appointment scheduling through an automated appointment scheduling software
2. Providing patient education materials that educate patients about coverage and patient responsibilities
3. Cross-checking insurance details with the respective insurers
4. Documenting the critical patient details
5. Real-time insurance verification to ensure that the data is up-to-date

Also Read:

10 Reasons to Consider Outsourcing Revenue Cycle Management Services

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Best Practices When Outsourcing Medical Billing Services

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Automating Healthcare Revenue Cycle Management Services for Faster Reimbursements

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8 Questions to Ask Before you hire a Medical Billing Company

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9 Proven Medical Coding Strategies You Don’t Want to Ignore

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SolvEdge Revenue Cycle Management Services

SolvEdge is a healthcare-exclusive revenue cycle management company that offers outcomebased medical billing services to Practices and Hospitals. Our Gap Analysis at No Cost is designed to evaluate your missed out revenues in 2020 and recoup those payments in 2021! To learn more about maximizing your medical billing performance, talk to our revenue cycle experts.