Why RCM Vendors Benefit From Real-Time Patient Eligibility Verification

Revenue Cycle Management (RCM) is the multi-step process that begins from the time of a patient’s appointment thru to when the patient’s bill is paid. A successful RCM process is critical for a healthcare practice to remain financially viable while also providing quality care to its patients.  Many RCM vendors use a wide range of tools and solutions today. Real-time patient eligibility verification is one of the key tools to improve workflow and increase cash flow.

Why do RCM vendors use real-time patient eligibility verification?  

In this blog post, we will learn how RCM vendors can benefit from real-time patient eligibility verification. 

Understanding Real-Time Patient Eligibility Verification

Obtaining accurate patient demographic and insurance information is a critical first step for a healthcare organization’s Revenue Cycle. Failure to do so can cause denials and delays in payment. Medical providers used to rely on multiple phone calls and websites to verify patient and insurance information however today with a robust real-time eligibility verification tool this can be done simply and quickly.  

Benefits gained from a real-time patient eligibility tool:

• Quick and accurate determination of a patient's eligibility for coverage & payment obligations.

• Reduction in claim resubmissions by submitting clean claims the first time.

• Reduction of eligibility and demographic-based denials and rejections.

• Increased upfront collections of patient responsibility.

 A healthcare system has numerous stakeholders so it’s crucial to  avoid fragmentation of care and inaccurate medical billing procedures, pharmacists, healthcare providers, and insurance providers or payers rely on accurate patient information. A reliable patient eligibility verification system helps RCM vendors by tailoring an accurate and efficient process to their specific requirements. This includes using AI and machine learning solutions to quickly and efficiently validate patient demographic and insurance data to reduce claim denials.

Reasons RCM Vendors need Real-time patient eligibility Verification

Increased Claim Pay-outs

The process of submitting a claim starts as soon as a patient walks into a healthcare facility or makes an appointment. This is entirely possible with real-time eligibility verification, as are timely and reasonable payouts. Medical practices should take full advantage of simple, low-cost software applications that allow the front office or reception to speed up patient registration without losing any information; this helps to increase claim payouts.

Increased Cash Flow

Verifying insurance coverage and benefits takes time and is hard to do because plans change and patient deductibles are high. The best way to deal with this problem is to use the tools built into the Electronic Data Interface (EDI), which can verify a patient's insurance eligibility and benefits in real-time. This significantly contributes to increased revenue. If your Electronic Health Record (EHR) system is reliable and error-free, you can check coverage automatically every day, week, or month with just one click.

Patient Satisfaction

Electronic real-time eligibility verification simplifies the overall front office process by allowing decisions on eligibility, coverage, and benefits to be made after a quick check with most payers. Immediate checks reduce risks such as patient plan expiration and llack of coverage for a specific procedure which have a direct impact on patient satisfaction.

When real-time eligibility verification is done right, the front office staff has more time to focus and prioritize other tasks. Quick processes and flawless payment procedures improve the overall patient experience as well. All benefits of real-time eligibility verification lead to improvements in a healthcare practice's bottom line. 

Wrapping Up

If you are an RCM vendor looking to gain the benefits from real-time patient eligibility verification, request a discussion with tevixMD.