5 Ways Insurance Verification Automation Can Improve Revenue, Productivity, and Care

More than 50% of doctors want to invest more time in patient care and education, according to a recent survey conducted by NexHealth†. But with over two-thirds of their time spent on paperwork, they can’t focus on their top priority –  caring for and educating patients.

Insurance verification: How much is it costing you?

Critical administrative tasks in a practice range from scheduling appointments, ensuring medical forms are accurately filled out, ensuring proper payments, including insurance billing.  Prior to billing, insurance verification, which includes understanding a patient’s deductible, maximum benefit, and remaining coverage, is typically a manual, time-consuming process that ensures a patient’s eligibility and insurance benefits coverage are verified.

"A large part of our staff's day is spent on insurance verification," says Maria Rogers, Business Office Director of Pinnacle Medical Group, where around 30% of the medical practice’s insurance verifications are handled manually. The team's current tool doesn't provide real-time information, and it fails to update deductible balances, resulting in additional work for the front office staff.

While insurance verification is time-consuming, not everyone agrees on the amount of time spent for this critical task. Seventy percent of office managers† say that insurance verification takes upwards of an hour a day; yet doctors think half the time - only 30 minutes - is spent by the practice on insurance verification. 

This difference indicates that there are 2.5 hours each week being consumed by manual tasks and office managers doing more labor than is realized by doctors. Regardless of the difference between perception and reality of the time actually spent on this process, the annual cost of manual insurance verification in dental alone is upwards of $835 million.

Mitigating Difficult Payment Discussions

Another challenge to insurance verification is the inability to inform patients of their financial responsibilities before the appointment. This creates discord between front desk staff and patients due to unknown coverage details before appointments, often leading to on-site cancellations and misunderstandings around service costs and bill payments.

“Understanding financial responsibility in advance of an appointment helps patients make a more informed decision about their care.  For the practice, having this information up-front, helps us decrease on-site cancellations which can be frequent if a patient is surprised by what is covered and what is not covered in their insurance plan," explains Rogers.

Automating the Insurance Verification Process

Automated insurance verification is a digital process that uses software to confirm a patient's insurance coverage and benefits in real-time or near real-time. This streamlines the verification process by automatically checking insurance details with the payer's database, eliminating the need for manual data entry and reducing the likelihood of errors. 

Automated insurance verification provides immediate information on a patient's coverage, including co-pays, deductibles, and any other out-of-pocket expenses, ultimately improving efficiency and accuracy in medical and dental practices.

5 Benefits of Automating Insurance Eligibility Verification

1. Increased Productivity and Time-Savings

Manual verification involves requesting insurance documentation, entering it into the system, and then contacting the payer to confirm eligibility. More than 35% of practices spend over an hour daily on this manual verification process and also acknowledge wanting to spend more time in other valuable areas such as patient care and education and improving in-person patient experience. This underscores the need for an automated solution to improve efficiency and productivity in the right areas.

An automated system can verify eligibility days before appointments, identifying patients lacking adequate coverage before their arrival. Synchronizing the tool with your practice management system can additionally streamline administrative tasks, further reducing time spent on these processes.

2. Reduced Claim Denials

65% of claims that were denied are never resubmitted, meaning the practice will incur financial losses if denied claims are not addressed. Automatically verifying insurance eligibility and benefits before appointments helps provide access to accurate information on coverage, co-pays, and deductibles. Additionally, it allows for the quick identification of inadequate or expired coverage, enabling staff to communicate with patients about their coverage status beforehand, preventing insurance claim denials - before they even happen.

3. Updated Information - Automatically

Switching from a manual to an automated process ensures you spend less time contacting patients and manually entering their information into the system. Instead of spending hours verifying information, using automated tools can confirm insurance coverage in seconds and sync eligibility summaries directly to your practice management system.

4. Faster Reimbursement and Revenue Growth

An automated tool minimizes delays in reimbursement processing by identifying ineligible coverage beforehand and ensuring that claims are submitted with accurate and verified information. As a result, the practice benefits from financial efficiency with faster turnaround times for reimbursement.

5. Improved Patient Experience

Patients who experience insurance coverage issues are more likely to delay necessary care.  That's why it's important to send the benefits coverage statement before the patient’s visit. This ensures patients are clearly informed about their financial responsibilities upfront, reducing surprises and uncertainties.

"A win at the front desk is a patient having a better understanding of their financial obligations a few days before their visit.  This information helps eliminate any tensions that can be caused by surprise bills related to insurance coverages. ” says Maria from Pinnacle Primary Group, “any education we can provide upfront–whether financial or clinical–is a win.”

What to Consider When Choosing an Insurance Verification Software

• Real-time verification: Opt for software providing real-time or near-real-time insurance verification capabilities to access the latest patient coverage information automatically and in real-time.
• Syncing with your practice management system or health record system: It’s important that the software seamlessly syncs with your current practice management system or health record system software to reduce manual input.
• No manual entry: A significant challenge lies in the manual data entry of patient coverage information to your system, which is prone to human error. Selecting verification software that can synchronize eligibility summaries directly into your practice management system not only enhances information accuracy but also saves you valuable time on manual tasks.

Automatically Verify Patient Eligibility with NexHealth

NexHealth Verification offers an immediate, high-level overview of a patient’s deductible, maximum benefit, and remaining coverage. The tool helps you verify patient information 7 days before their visit and on-demand, ensuring your team is always prepared for billing. E-verification provides the most up-to-date data from the insurer in real-time, helping your practice get paid without the need to resubmit claims or chase accounts receivable. Learn more: https://www.nexhealth.com/features/nexhealth-verify

†NexHealth survey conducted in May 2024