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5 Reasons to Incorporate Eligibility Verification in Revenue Cycle Management

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Effective revenue cycle management (RCM) is the foundation of a successful practice, and effective RCM begins immediately with patient eligibility verification. Verifying the patient’s insurance details, such as coverage, copayments, and deductibles is required to determine eligibility. The patient eligibility verification technique entails confirming that the patient’s insurance coverage corresponds to the billing method used. This may occur for several reasons, including the patient being charged for a separate operation by a different doctor or their insurance policy claiming coverage for the wrong surgery.

The profession itself takes a long time to determine each patient’s eligibility. The practice staff finds it extremely challenging to balance their daily tasks while calling the health coverage payer to determine each patient’s qualification before the appointment. The main reasons for incorporating eligibility verification in revenue cycle efficiency are covered in this article.

Strategies For Enhancing the Patient Eligibility Verification Process 

Leverage Technology

Using real-time, cloud-based software gives the most recent data about patient coverage so one can make a sensible choice. This alerts to any payment delays or denials from the payer. This routine helps in getting over potential future rejections. Various revenue cycle management services can assist in optimizing the process as a whole.

Monitoring and measuring your progress in reducing denials is a constant exercise that acts as a scorecard. A reliable monitoring system for denials combined with analytics might be of great use in evaluating your denial rate. Based on a comparable sort of denial from the same payer in the past, predictive analytics can provide insights into which specific claim bears a high likelihood of denial.

Audit and Train

The first step is to identify the procedures that are currently being used to confirm a patient’s eligibility. After being familiar with these procedures, each step must be carefully reviewed. Ineffective practices are known to lead to common errors. Staff members can continue to maintain checks on the practice through routine training sessions on eligibility verification.

Importance of Insurance Eligibility Verification for Revenue Cycle Management

Before the patient’s visit or admittance to the hospital, the insurance approval process must be completed. It will ensure that no claims are turned down and that the remaining procedure is achieved easily. If a claim is turned down, it becomes exhausting to submit another, and the practice may eventually stop receiving funds. Patient portals of insurance eligibility verification can be used as an alternative to telephone communication if it appears commonplace and unproductive.

5 Reasons to Incorporate Eligibility Verification in Revenue Cycle Management

Error-Free Claims

The submitted claims won’t be rejected because of socioeconomic factors or other mistakes if the information is valid. It will allow practitioners and revenue cycle employees to submit accurate claims, increasing collections and improving patient satisfaction and experience.

Improved Cash Flow

Increased cash flow, fewer unpaid claims, and patient satisfaction will result from the practice’s consistent, clean claims submissions, fewer denials, and improved income streams.

Enhanced Self-Pay Income 

Self-pay revenue will increase when patient data is electronically connected to the healthcare database. Supporting patients with opaque coverage and submitting claims after online eligibility and coverage checks improve fund transfers for self-pay clients.

Direct impact on claim denials and payment delays 

Reducing claim denials requires a methodical and planned eligibility verification process. Verifying insurance coverage makes it easier to process claims immediately; however, failing to do so results in many drawbacks, like poor patient satisfaction, increased errors, claim delays, and denials.

Streamlined Workflow

With insurance verification, the revenue cycle significantly optimizes RCM workflow and provides space for a better patient experience; the procedure requires organizing information efficiently.


One of the crucial steps in the entire revenue cycle management is the insurance eligibility verification procedure since it directly affects the approval of claims and the timeliness of payments.

Healthcare facilities use medical billing software to monitor patient care incidents, from enrollment and consultation schedules to the balance payment date. This process is known as revenue cycle management (RCM). By combining data collected, like the patient’s name, health insurer, and other private details, with the treatments a patient gets and their healthcare data, RCM unites the commercial and medical aspects of healthcare.

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