First impressions shape relationships, and as a provider, your first substantive interaction with a patient is enrollment, registration, and insurance verification. These processes have traditionally been fraught with paperwork on both sides of the interaction.
The work is tedious in the best of circumstances, but errors of any kind can sour the relationship for the long term. Integrated health care providers can have problems down the road, including insurance-verification problems and payment denials.
Registration mistakes can also have life-or-death consequences. Horror stories include clerical errors leading to shock diagnoses delivered to the wrong people, DNRs attributed to the wrong patient, or even medications going to the wrong person.
“Successful RCM (revenue cycle management) hinges on remembering that each step of the cycle is linked,” says AAPC, the RCM health care credentialing organization. “A problem in one area can ripple out to create problems in other steps.”
Overcoming these issues means greater patient satisfaction and ultimately more revenue for you.
Toward better eligibility verification
In the eligibility verification process, providers typically require information like:
- Legal name, address, dob
- Medical history
- Emergency contacts
- Consents
- Confirmation the patient has received and read disclosures
Insurance verification requires confirmation of coverage, copays, deductibles, and out-of-pocket maximums. Incorrect cost estimates alienate patients.
Among other things, patients hope for a good estimate of their expenses. Although 2 out of 3 providers think their organization provides clear estimates prior to care, not everyone gets an estimate, according to Experian Health. Of those who don’t, 2 in 5 say the final cost was more than they expected.
At HiMS, we believe technology can reduce red tape, errors, and unpleasant surprises for everyone. We’ve studied the on-boarding process in depth, scrutinized common points of failure, and introduced powerful new technology to automate these processes and ensure accuracy.
Our AxiomRCM software features automation including advanced analytics and AI which help ensure the entire patient experience is captured correctly throughout their journey. From the start, the technology prepopulates forms, verifies identities, deduplicates records, and flags mistakes.
According to CAHQ, electronic eligibility and benefit verification saves the medical industry $9.8 billion per year and saves medical providers 21 minutes per transaction. For our customers, the average eligibility verification process in the past used to require 7 days. With the advent of AI in AxiomEHR, providers and their patients have reduced that time to 1 day with no manual entry.
Provders are feeling the difference in their efficiency and bottom lines. And patients are getting started on the right foot, leading to rewarding relationships that can last lifetimes.
