Upfront Patient Eligibility Processes Can Eliminate Claim Denials

One of the most crucial front desk functions is verifying patient eligibility for scheduled procedures. Some healthcare facilities handle this step on their own and others get healthcare BPO services. Either way, accurate and timely submission of patient coverage information helps to prevent claim denials.

Therefore, you want to make sure the front desk is equipped with resources and knowledge for checking details. Determining patient payment responsibility and out-of-network benefits can also cut down denials and delays.

Let’s look at some common reasons for claim denials and learn how addressing these challenges upfront will help your facility.

Claim Filing Delays

Typically, there is a 60 to 90-day window from the time of a procedure or operation for filing claims with an insurance provider. Submitting a claim after the stipulated time can result in a denial.

You can avoid this scenario by ensuring front desk staff understands their role in filing all claims on time.

Insurance Plan Updates

Life situations may cause a person to make changes to their healthcare coverage. If so, it is equally important that you also have the latest update. Filing a claim based on old information can lead to that claim being denied.

Alternatively, conducting fresh eligibility verifications before an appointment guarantees your system matches the provider’s information.

Specialist Referrals

In some cases, the healthcare insurance provider requires a referral and authorization from the primary care physician for certain procedures. Providing treatment without a referral will result in the medical claim being denied.

Make sure your front desk staff is trained in following referral procedures according to the insurance policy.

Verifying patient eligibility has a direct effect on how well, or poorly, your healthcare facility maintains a healthy cash flow. GeBBS Healthcare Solutions, Inc. wants to ensure your upfront eligibility process results in consistent approval. Get more information at our website on how our healthcare BPO services solve your billing challenges.

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