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Sep 15, 2023 5:37:44 AM Practice EHR

The Cost of Neglecting Eligibility Verification in Medical Billing

Healthcare is a pretty complex realm, and medical billing is the supporting pillar in this realm. In simple terms, medical billing is the process through which healthcare providers receive payment for their services, ensuring the financial health of their practice. There's a critical step in this process that often gets overlooked or underestimated: eligibility verification. Neglecting this crucial aspect can be followed by far-reaching and grave consequences, both financially and in terms of patient satisfaction.

In this blog, we'll delve deep into the cost of neglecting eligibility verification in medical billing, what are the possible solutions to this problem, and explore how using Practice EHR can help mitigate these risks.

Eligibility Verification Matters

Understanding Eligibility Verification

Before exploring the repercussions of overlooking eligibility verification, understanding what it entails is crucial. Eligibility verification is the process that involves confirming a patient's insurance coverage and determining their financial responsibility for a healthcare service. Further details of this process involves checking whether a patient's insurance is active, what services are covered, and what their copayment or deductible might be.

Why Eligibility Verification Matters

1. Revenue Loss

One of the most immediate and tangible consequences of neglecting eligibility verification in medical billing is revenue loss. When providers don't verify a patient's eligibility before rendering services, they risk treating uninsured or underinsured patients. This means they might not get reimbursed for the services provided, leading to a significant dent in their revenue stream. It's like giving away services for free.

Rejection of a claim is also a cost that doesn’t come bearing any returns.

2. Increased Denials

Incomplete or inaccurate eligibility verification can result in claim denials. Claim denial means that all the time spent prior by the administrative for the claim submission has gone to waste, which is a financial loss to the practice.

Insurance companies are notorious for rejecting claims if the patient's eligibility or coverage details are not accurately recorded. Denied claims not only delay revenue but also add administrative overhead as staff must resubmit and appeal these claims.

3. Patient Frustration

Imagine the frustration a patient experiences when they receive an unexpected bill for medical services they thought were covered by their insurance. Such situations can lead to patient dissatisfaction and even damage the reputation of your practice. Patients who feel financially burdened by unexpected bills are less likely to return for follow-up care or recommend your practice to others.

There are several case studies that show that patients tend not to return back to their long-term doctors if they face the issue of claims rejection, and they are likely not to spread positive word of mouth among their circle, no matter how good the doctor is.

4. Administrative Costs

Neglecting eligibility verification also leads to increased administrative costs. Staff must spend valuable time correcting errors, resubmitting claims, and addressing patient inquiries and complaints related to billing discrepancies. These administrative tasks can be time-consuming and divert resources away from patient care - all the money that was directed towards catering to a claim submission that is rejected by the insurance company could have been spent on taking care of patients.

Best Practices for Eligibility Verification

All the issues mentioned above can be neglected if a practice opts for the services from a good medical billing company. These companies have trained expert medical billers who are explicitly trained to ensure the best possible claim submission and eligibility verification. Getting these professional services significantly decreases claim rejections.

While getting services from a good medical billing company can significantly improve your eligibility verification process, it's essential to follow best practices to maximize its effectiveness:

1. Verify Every Patient

Don't make exceptions when it comes to eligibility verification. Verify the insurance coverage of every patient, regardless of their insurance history with your practice. Insurance details can change, and assumptions can lead to costly mistakes.

2. Communicate with Patients

Inform patients about the importance of providing accurate insurance information and updating it when necessary. Encourage open communication to avoid surprises related to billing.

3. Train Your Staff

Properly train your staff on how to use Practice EHR for eligibility verification. Ensure that everyone involved in the billing process understands the significance of this step and follows the established procedures.

4. Regularly Update EHR

Keep your EHR system up to date with the latest patient information, insurance details, and billing codes. Regularly updating the system ensures accuracy in eligibility verification.

All of these services are provided by the Practice EHR - we provide 360-degree medical billing and electronic health records and also train the staff of practice in how to automate the operations of the practice.

PracticeEHR The ONE Solution

Practice EHR - The ONE Solution for Eligibility Verification

Now that we've established the importance of eligibility verification let's explore how Practice EHR can be a game-changer for your medical billing process.

1. Real-time Verification

Practice EHR offers real-time eligibility verification, allowing you to instantly confirm a patient's insurance coverage and financial responsibility. This feature prevents the treatment of ineligible or underinsured patients, reducing revenue loss and claim denials.

2. Accurate Documentation

With Practice EHR, you can accurately document a patient's insurance details within the electronic health record (EHR) system. This ensures that all billing information is correctly recorded and reduces the risk of claim denials due to incomplete or inaccurate data.

3. Streamlined Workflow

By integrating eligibility verification into your EHR system, Practice EHR streamlines your workflow. This means fewer administrative tasks related to billing discrepancies, reducing the overall administrative burden on your staff.

4. Enhanced Patient Experience

A positive patient experience is vital for any healthcare practice. By using Practice EHR to ensure accurate billing and insurance information, you can minimize surprises and frustrations for patients. This, in turn, leads to higher patient satisfaction and loyalty.

5. Financial Security

Practice EHR's eligibility verification helps ensure the financial security of your practice. With accurate billing and reduced claim denials, you can improve cash flow and maintain a healthier bottom line.


Neglecting eligibility verification in medical billing can come at a high cost, both in terms of revenue and patient satisfaction. To avoid these consequences, it's essential to implement a reliable solution like Practice EHR. By incorporating real-time verification, accurate documentation, and streamlining workflows, you can enhance your practice's financial stability while providing a better experience for your patients. Don't underestimate the power of eligibility verification; it's the key to a thriving and patient-focused healthcare practice.

In the ever-evolving landscape of healthcare, staying ahead of the game is crucial. Practice EHR empowers you to do just that by ensuring your eligibility verification process is seamless and efficient. It's not just a tool; it's an investment in the financial health and reputation of your medical practice. So, take the leap and embrace the future of medical billing with Practice EHR. Your patients and your bottom line will thank you.

To get your FREE DEMO, reach out to us today and elevate the services and productivity of your practice. Be the part of those practices in the United States of America that claim that their revenues have increased up to 40% after integrating Practice EHR into their practice. With that, you can also get a free consultation session from our experts!!!!

Topics: Integrated EHR, EHR Solution, New Technology, Medical Billing, RCM, Eligibility Verification in Medical Billing




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