Eligibility Verification ? Impact on Denials

Posted by Ecareindia on May 21st, 2013

The increased rejection of claims has forced many Healthcare Providers and medical billing companies to perform audits before sending their claims for billing. Invalid CPT or ICD Codes, wrong patient demographics, and missing EOBs are some of the several factors, which influence claim denials. Though almost all of these factors are taken into consideration during review, claims still get denied by the payers. The reason is pretty much simple! In addition to these factors, there is yet another aspect called the insurance eligibility verification that most Providers and billing companies fail to consider. Let’s see how well a healthcare billing company handles this factor during medical claims processing,

Obtain Patient Schedule: The first step in the eligibility verification process is to obtain a patient’s appointment schedule from the Healthcare Facility through email, fax, or web. An offshore company with a dedicated team of professionals adept in insurance eligibility verification may do this job perfectly.

Coverage of Services: Once the appointment schedule details are received, the patient’s eligibility factors will be checked one by one with the insurance carrier. The main criterion to be verified is the healthcare services covered under a patient’s insurance policy coverage. It will be a huge loss for the Provider if the services rendered do not come under the policy coverage. A prudent choice to avoid such a loss would be outsourcing medical insurance billing and coding to an offshore healthcare billing company.

Insurance Coverage Period: The next eligibility factor is the insurance coverage period, which should be checked in advance to providing services. A patient cannot enjoy healthcare services if his/her insurance policy’s coverage  validity has expired. If this factor is overlooked, then it will have a great impact on the Provider’s and healthcare billing company’s revenue cycle management.  

Referral Details: Some specialty services might require a referral from the primary Healthcare Provider. A patient has to submit such referral details before taking services from the Provider, else the claims might get denied.

Updating the EHR: Once all these factors are verified, the details are updated in the EHR/Billing system. These details will stand as proof in the event of claim denials despite checking for insurance eligibility factors. A reputed offshore company like e-Care India can perform this job exceptionally well, apart from checking the other insurance eligibility verification factors.

About e-Care India:

e-Care India is one of the renowned medical billing companies in India that promises the above mentioned benefits with total customer satisfaction. With 13 years of experience in the industry, e-Care’s offshore healthcare billing delivery centers have been providing end-to-end medical insurance billing and coding services seamlessly to its clients. To know more about e-Care and its services, log on to www.ecareindia.com

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Joined: June 20th, 2011
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