Did you know that 30-60% of write-offs are due to eligibility losses that are preventable prior to patient care? Now for the shocking part: this is for hospitals that already have automated insurance verification systems!
Moving eligibility data from payer to booth is the illusion of a solution without any in-depth auditing to identify eligibility failures before they become losses. Eligibility verification systems have to do more than move data – that’s just the first step out of four.
The second step is interpreting eligibility transactions and presenting data in a concise, organized way that the user can understand.
The third step consists of in-depth auditing for coverage, benefit issues, and demographic variances.
The fourth step is enforcement; alerting the registrar and managing issues until they are resolved, escalating and notifying supervisors if issues are unresolved prior to service. This step also includes performance tracking for accuracy and resolution rates so there is visibility and accountability for unresolved eligibility issues – at the system, facility, location, and employee level.
As you can see, there are many elements eligibility verification systems require in order to enforce accuracy at the front door and empower registrars to drive revenue cycle results.
Take a look at your eligibility losses and question your process, it could change your bad debt ratio.