Automated Eligibility Verification – The Most Efficient Way to Perform the Most Critical Step in Medical Billing

If you’re not checking eligibility, you’re running the risk that you won’t get paid for services and we have a PHENOMENAL way to do it!

Nobody wants to work for free! But that is exactly what happens when a patient is seen and the claim for services rendered is uncollectible because the patient didn’t have coverage. The cost of that service extends beyond just the providers time, it extends to the staff that took time to schedule and check the patient in and out, the nurses and medical assistants, and billers that took time to send out the claim. Which is why the most critical step in medical billing is to verify patient eligibility prior to the patient ever being seen, and there is a good, better and best way to do it!

Let’s start with when to check eligibility:

  • New Patients – When a new patient calls to schedule an appointment the first thing an office should do is ask for insurance information and run an eligibility check to verify coverage. It’s not just good for the practice, it’s a matter of good customer service. No patient wants to find out after the fact that the practice doesn’t take their insurance or that they are out of network. Having information regarding coverage and the deductible allows practices to have up-front conversations with new patients so they can make informed decisions.
  • Scheduled Appointments – There are so many factors that can impact changes in healthcare coverage. Lost jobs, employers changing insurance companies, employees selecting a different option offered by their employer, deciding to switch coverage to a spouses plan, and on and on. These changes can come at any time. Because appointments can be scheduled months in advance, whether you are seeing a new or existing patient it is a best practice to verify eligibility for every scheduled appointment a few days in advance of the appointment. This allows the practice time to address changes in eligibility with a patient prior to seeing them. And just as a tip- if the appointment falls on the first day of the month it’s always a good idea to check it again that day because most plans term on the last day of the month.

Now, we can talk about the different ways to verify eligibility:

Good: Call the insurance company to verify. The down side of this method is that it can take a lot of staff time, it can be frustrating to patients (imagine the first impression it makes when the staff either needs to put a new patient on hold or telling them you will call them back once you have verified eligibility), and there is a high risk that it won’t get done. Even if you have a dedicated staff member to make calls for all of the scheduled appointments it’s pretty common for them to get interrupted with other duties or get stuck waiting on hold making it difficult to complete the list.

Better: Verify eligibility online. Many insurance companies allow you to verify insurance through their website, or through a clearinghouse. While this is more efficient than calling the insurance and getting stuck on hold, it is still a manual process to go to the site or clearinghouse and key in the information. The impact of this method is the drain on staff time, potentially lower patient satisfaction, and a high risk that it won’t be completed 100% of the time.

Best: Real-time and Scheduled Eligibility checking directly from Medisoft.  When you couple Change Healthcare clearinghouse and Medisoft together you unlock the real power of automation because everything is tightly integrated directly into Medisoft. For example, when registering a new patient you can enter the insurance information and with the click of a button do a real-time eligibility check. Eligibility information is pulled right back into Medisoft for viewing. No leaving the window, making phone calls, or re-entering the same patient demographic and insurance information all over again on another site! Real-time checks can also be done when scheduling existing patients to verify the insurance on file is up to date. What about all those scheduled appointments? Medisoft can automatically run eligibility for an entire day of appointments all at once a few days in advance so you know which patients still have coverage and which ones to reach out to before they come. 

If you’re practice is ready to run at it’s best and automate just one more step in checking eligibility, this video is for you!

Now that you see how easy that can be, we want you to know first hand some of the ways our customers are saving on setting up scheduled eligibility through Medisoft.

  • Save time by not being on the phone for hours
  • Save the hassle of rescheduling and cancelling appointments
  • Save money on sending statements

We can show you 6 different ways this clearinghouse will legitimately save you boatloads of time and money in Medisoft – check the link out for yourself.

Give us a call today!

We know first hand how scary it can be to switch to a new clearinghouse, and Medisoft is your solution to making life a bit easier. We’ve helped hundreds of practices make the switch and we’ll make it a quick and painless process.

Call us today to ask your questions, to get the details, and to discuss the process for moving from your current clearinghouse to the RIGHT clearinghouse. Let us help you get to a place where you can enjoy extra time, a streamlined and simple electronic claims process, and maximized revenue.

AZCOMP Technologies – the #1 eMDs reseller for Medisoft since 2005.

We are the ultimate source for all things Medisoft. Whatever your question or problem or need with Medisoft, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as the Medisoft preferred clearinghouse, or patient statements, patient payments, appointment reminders and more.

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Be sure to call us at (480) 730-3055 for all your Medisoft and healthcare technology needs.