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Benefits of Automating Your Insurance Eligibility Verifications

May 2, 2024

The first step in the healthcare revenue cycle is insurance eligibility verifications. This is also the first place where inefficiencies can happen, resulting in increased revenue cycle problems. Insurance providers frequently change and can lead to denied claims, increased patient balances, and scheduling problems if there are inaccuracies in the verification process. Many revenue cycle leaders are looking to artificial intelligence to automate their insurance verification processes. Since the healthcare revenue cycle consists of many inefficient and repetitive processes that significantly add to the administrative waste burdening our healthcare system, they are a clear candidate for automation. While completing such tedious tasks can cause employees to become burned out and bored, claims become backlogged, and negatively impact patient experience and the hospital's bottom line. Automating insurance verifications has many benefits.

1. Claim Denials Are Reduced

Managing denials and denied claims create a significant amount of work that becomes too much for employees to address. This leads to increased write-offs and patient balances. Most denials are preventable, but only half of them are recoverable, so the best strategy to manage them is to reduce the number of rejections that occur in the first place. One-fourth of denied claims occur from registration and eligibility issues. But, when you let automation take on the task of verifying insurance eligibility, benefit checks can be completed more accurately and frequently than humanly possible. By removing errors that usually occur initially, denials are also eliminated.

2. Freed Up Time

To manually check benefits can take an employee up to 10 minutes to complete. To best support their revenue cycle, it's nearly impossible for humans to thoroughly and accurately complete insurance verification checks at the cadence required. Accuracy is improved by implementing artificial intelligence and automatically frees employees to focus on other essential tasks that require a human touch.

3. Patient Experience Improved

Patient satisfaction and the healthcare revenue cycle are directly tied to each other. Negative patient experiences with billing may cause anger and frustration that can impact their overall experience even if they are satisfied with their care. Patients need staff to explain costs clearly and correctly check their benefits since patients take on financial responsibility. When patients are told out of nowhere that their test or procedure isn't covered by their insurance provider or receive an unexpected bill, their overall experience is tainted. With automation, staff has more time to explain benefits better and educate patients on costs, increasing patient satisfaction.

4. Improve and Accelerate Cash Flow

Manual touches, patient balances, and claim denials are reduced when benefits and eligibility are entirely correct and cash flow increases. When claims are denied and resubmitted, this slows down the reimbursement time. When benefits are accurately checked, patients will pay the correct amount the first time and won't get hit with an unexpected bill. When all of these processes have to be manually done, it takes up the staff's valuable time. Time is money, and when it isn't spent working on tasks that can be automated, it can be redirected to other functions that will improve cash flow, such as denied claims and patient balances. Administrative hiring can be scaled back over time due to using automation for insurance verification processes.

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