Improving patient eligibility verification is a top priority for healthcare organisations. According to the CDC, about 1 in 10 Americans cannot be verified as eligible to receive healthcare services, a problem known as ghosting. In addition, the costs associated with the current manual system are unsustainable and pose a risk to an organisation’s compliance and financial standing.  To avoid future penalties, it’s critical that you implement an automated solution for verifying patient eligibility and identity along with an integrated registration process.  This comprehensive guide from medzinc will help you understand why your organisation needs to improve its patient eligibility verification processes, explore various solutions for automating the process and provide best practices for implementation.

Why is Patient Eligibility Verification Important?

First and foremost, verifying eligibility ensures that low-income residents who qualify for government-funded healthcare programs are able to receive the care they need.  It also makes sure that government funds aren’t used to pay for services for people who are ineligible. Additionally, it helps prevent fraud and abuse of the system by verifying patients’ identities and making sure they aren’t using someone else’s insurance information or receiving fraudulent benefits.  Another reason to improve your eligibility verification processes is the risk of non-compliance. Moreover, Healthcare organisations that fail to meet HIPAA and HITRUST guidelines are at risk of heavy fines and penalties.  One way to avoid these penalties is by implementing a patient eligibility verification system that fully automates the process, making it impossible for human error to occur. 

Automated Eligibility Verification Solutions

Depending on your goals and needs, there are many ways to improve your patient eligibility verification processes.  To fully automate the process, you need to integrate a solution that’s capable of :

• Firstly, checking eligibility databases, 
• Secondly, collecting patient information, 
• Thirdly, making a determination and printing a receipt. 

As you research automated solutions, keep these points in mind: 

• What is the solution’s level of automation? 
• Does it integrate with your existing systems? 
• What database and database sources does it use? 
• Does it collect the minimum required information? 
• Can it make a determination based on the information collected? 
• Does it print a receipt? 
• What type of database integrations does it support? 
• What identity proofing services does it provide?

Best Practices for Improving Patient Eligibility Verification

To fully automate your eligibility verification process, you need an all-in-one solution that can 

• Firstly, collect patient information, 
• Secondly, check the appropriate databases,
• Thirdly, make a determination and provide a receipt. 

To help you find the right solution for your organisation, keep these best practices in mind as you research and evaluate potential solutions: 

Find out why patients are being verified.

By knowing the reasons why customers are being verified, you can make sure the solution’s capabilities match their needs. For example, if the majority of your patients are being verified as part of a government program, look for a solution that integrates with the relevant databases.  If a large number of patients are being verified as part of your organisation’s internal compliance program, look for a solution that can check internal databases. 

Verify that the solution performs well during peak times.

Because you want it to be fully operational during high-volume periods, make sure the solution’s performance is reliable even when the system is operating at full capacity. 

Choose a solution that’s easy to integrate. 

Ideally, you want a solution that’s designed to work with your current infrastructure and can be deployed in a short period of time.

Key Takeaway

Improving patient eligibility verification is a top priority for healthcare organisations. To avoid future penalties, it’s critical that you implement an automated solution for verifying patient eligibility and identity along with an integrated registration process.  Now that you have read this comprehensive guide on improving patient eligibility verification, you are better equipped to make the right decisions for your organisation. Whether you need to integrate a solution with your existing systems or verify patients against government databases, this guide can help you understand your options.