Posted at 13:34h in Cost of Health Care, Medical Billing

Patient insurance coverage frequently changes, which can lead to missed details when tracked manually. This often results in claim denials and subsequent reimbursement issues.

This article explores the benefits and effectiveness of automated eligibility coverage tracking platforms designed to address these challenges effectively.

The Problem: Manual Tracking Just Doesn’t Cut It Anymore

Determining a patient’s status as well as his or her insurance is a crucial but time-consuming process in the billing department. Previously, it included calling insurance companies, verifying the data in different systems, and entering the information into spreadsheets.

Since patient details are dynamic and various claims need to be addressed every week, it becomes impossible to manage information updates through traditional methods. Some of the problems include:

• Time-Consuming Process – Verifying coverage manually can take up to 30 minutes per patient. For large billing companies, this may translate into big time losses.
• Human Error – Manually compiling and updating records inevitably leads to inaccurate or outdated information falling through the cracks.
• Claim Denials – Incorrect policy details lead to higher denial rates, payment delays and lost revenue.
• Lack of Visibility – With records scattered across systems and spreadsheets, billing teams lack clear visibility into coverage changes.

Traditional ways of checking eligibility can’t keep up with increasing patient numbers and complexity. Billing teams handling medical billing denials and solutions urgently require automation support to manage this crucial data.

Automated Eligibility Verification and Coverage Tracking Systems: What Can They Do?

In response to these eligibility tracking challenges, a wave of automated coverage verification platforms have emerged to transform the existing manual process.

So, what exactly can these platforms do? Key capabilities include:

Automated Verification and Reverification

Software that provides medical billing solutions automatically verifies eligibility and coverage details upon patient admission. This provides billing teams with accurate, up-to-date information from the outset.

To maintain this, they run scheduled re-verifications automatically. This identifies any policy changes like switched insurers, changed coverage levels or terminated policies. It’s no longer necessary to manually phone insurance providers or trawl through spreadsheets. The system handles it automatically.

Proactive Change Notifications

Such software can automatically alert staff via email or other means about any issues with a patient’s insurance coverage or eligibility, enabling them to promptly address these issues.

Access To Hundreds of Payers

The verification software facilitates client access to check patients’ eligibility across more hundreds of payers using Web, Mobile, and API access, all through a unified platform.

Synchronization Across Systems

Leading platforms don’t operate in isolation. They ensure that eligibility data is shared across patient management, EHR, and practice management software, keeping the patient view consistent across all the systems used by the facility staff.

Evaluating Automated Coverage Tracking Systems

Coverage changes tracking stands out as the most critical feature in eligibility verification software. With so many advanced tracking systems now available, how should billing managers evaluate which is best for their needs? Here are some key criteria to consider:

1. Accuracy – The system’s verification processes must provide genuinely accurate and up-to-date eligibility data. This relies on regularly maintained integrations with major insurance providers.
2. Coverage – To support all patient types, the system should check eligibility across private and government-funded insurers like Medicare and Medicaid.
3. Notification Customization – It’s beneficial to direct notifications for coverage changes to billing staff who can promptly handle them, rather than burdening managers who may have limited time for patient-specific updates.
4. Data Handling – HIPAA-compliant data handlingis essential, as well as fast and reliable cloud hosting.
5. Interoperability –  It’s crucial that the software seamlessly integrates with major EHR, practice management, and revenue cycle management systems for smooth eligibility data exchange.
6. Support and Training – A reliable provider should offer onboarding, ongoing support, and dedicated customer success .

Using these criteria helps billing leaders objectively evaluate verification platforms based on their revenue cycle needs.

Best Cases: Using Approved Admissions

While capabilities and criteria help assess automated eligibility systems, which results do technology leaders experience from implementing these platforms?

Billing verification software provider Approved Admissions shared some metrics that demonstrate the revenue and efficiency gains:

• 98% Clean Claims Rate – Near-perfect claims accuracy minimizes costly denials and write-offs.
• Reduction in Manual Tasks – Automated verification and tracking eliminates huge manual effort.
• Months of Saved Time – Manually conducting eligibility verifications may take 15-30 minutes per patient. Automating this process for thousands of patients adds up to phenomenal time savings.

These metrics show that despite the initial software investment, automated eligibility tracking delivers rapid revenue gains and efficiency improvements that quickly justify the cost.

Platforms such as Approved Admissions, which feature fixed and transparent pricing models, make calculating ROI straightforward for billing managers

Integration

Implementing eligibility verification and coverage tracking software is straightforward due to its integration capabilities. Such tools typically seamlessly  integrate with existing platforms, requiring minimal effort from client developers. Pre-configured settings for popular platforms facilitate quick connections to a wide array of data sources.

The seamless interchange accelerates processes and enhances the ability to manage patient data effectively.

Conclusion: A Compelling Value Proposition

Manual eligibility tracking is tedious, error-prone, and expensive to billing companies and healthcare facilities in terms of lost revenue and denied claims.

As mentioned earlier, automated coverage verification platforms can confirm eligibility through various methods. This optimization ensures valid reimbursement, reducing significant administrative costs and covering their initial investment multiple times.

In light of the potential for substantial efficiency gains and revenue recovery, automated eligibility tracking platforms should be a priority for every billing and revenue cycle manager.