Insurance coverage for patients that is incomplete or delayed is one of the main sources of frustration for any medical business. Consequently, patients attend appointments without covering any of their copays, deductibles, or upfront costs, which raises accounts receivable (AR). Your employees are merely unable to keep up with the front-end operations and finish the insurance eligibility process on time!

Eligibility problems may lead to claim denials in addition to unpaid upfront copays or deductibles from incomplete eligibility. As a result, the staff will be under even more stress as they deal with the appeals process or, in the worst case scenario, have to charge the patient because their insurance plan did not cover the procedure. According to an MGMA survey, 15% of respondents said eligibility was the main reason for claim denials, while 5% said out-of-network was. If the front office had taken care of all the eligibility paperwork before the patients were seen, 20% of their participants' medical claim denials would have been avoided.

Depending on how long it takes to appeal the refusal, denials might cause claims to be paid three to six weeks later than expected, which adds to a significant arrears. To exacerbate the situation, staff time lost handling each appeal is estimated to be worth $100 per claim. The expenses keep piling up!

Isn't it convenient to have someone else take care of confirming for you the patient's insurance plan's coverage of the service as well as any out-of-network costs and copays? ensuring that when the patient checks in, all of this information is available.

Eligibility verification is the first stage in Billed Right's revenue cycle management service.