Frontline Defense: How Insurance Eligibility Checks Help Clinics

Casey Waldron | May 8, 2019 at 7:03 AM

The waiting room bustles with patients and their families. The phone rings, the fax machine beeps, and another email notification arrives. With a variety of distractions and competing priorities, clinic staff might not get around to running insurance eligibility checks in advance of the day's appointments.

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But checking patients' insurance eligibility should be prioritized. It is important both for your patients and for your clinic's bottom line.

Why Use Eligibility Checks

Collection of Co-Pays

With eligibility checks completed before the patient's appointment, the front desk staff will be knowledgeable about the patient's co-payment. Staff cannot collect what they do not know about. And with co-pays totaling an average of $144,000 in clinic revenue per physician per year, missing a chance to collect a co-pay can cost you.

Patient Knowledge

By running insurance eligibility checks, clinics can inform patients in advance about their financial responsibility to pay on the visit or procedure. Staff can work with patients prior to the visit to schedule payments, so patients are not caught off guard at their appointment. If the patient is unable to pay at the time of service, staff can propose possible payment plans ahead of time to help speed up the collection in full.

Better Experience

Having eligibility checks done prior to the patient visit can speed up the check-in process. A faster check-in reduces patient wait times and the amount of paperwork patients need to complete. Information from the eligibility check, such as the financial responsibility portion, can be shared with them. This addresses the 45 percent of patients who complain that there is not enough information provided to them at medical offices.

How to Improve Eligibility Checks

Build Requirements Into PM

Information is key to the eligibility check. Collect the insurance information prior to the visit. If possible, build requirements into your practice management system (PM) so schedulers gather the information during the phone call prior to the visit.

Implement Focused Workflows

In today’s world, not all visits are scheduled by phone, which makes the gathering of insurance information prior to a patient’s visit more difficult at times. Allocate staff resources to reach out to patients who schedule appointments online or through mobile apps to gather their information in advance. Do not allow the patient to complete the online scheduling until all required insurance information is entered.

Train Your Staff

A more knowledgeable staff can help in the process. Make sure staff members understand why eligibility checks are important to your clinic and how they can help in the process. During their training, they may have questions or ideas that could help improve your processes, so be sure to listen and invite their input.

Benefits of Insurance Eligibility Checks

Improved A/R

Days in accounts receivable (A/R) average 35 to 45 days, so it usually takes months for you to fully collect your money. Insurance eligibility checks can reduce days in A/R by making sure the patient’s plan covers the visit so the insurance is not rejected. Payment plans can be agreed upon prior to appointments, and a credit/debit card can be kept on file to take pre-arranged payments automatically without the need for collections.

Better Patient Experience

People choose services based on their experience. If patients have a positive experience and feel they are taken care of every step of the way during the visit, they are more likely to return to your clinic for future healthcare needs. Performing insurance eligibility checks before visits will improve the overall patient experience.

PCIS GOLD can make the process even easier through our advanced practice management and electronic health records systems. Contact us today to find out how we can help you improve your office workflows with automatic insurance eligibility checks.

Tags: Communication, Technology, Collections, Accounts Receivable, Revenue Cycle Management, Patient Relations, Automation, Insurance Eligibility

Casey Waldron

Casey is a seasoned sales and marketing professional with 18 years combined experience in D2D and B2B sales environments. Casey joined PCIS Gold in March of 2017 and is responsible for business development in all 50 states.