Patients Verifying Eligibility at the Time of Service

Administrative costs already account for 30 percent of the $2 trillion healthcare industry. As the industry moves toward higher deductible plans, providers need to start implementing new technology to ensure the patient or payor makes payment.

To accomplish this, the healthcare industry must move toward a retail-based solution where payment is collected at the point of service. Providers and patients can no longer wait to receive information. Doctors need to know a patient’s benefits as quickly as possible with the least amount of effort.

The responsibility of verifying a patient’s benefits falls into the hands of the front desk staff. In the current system, less than 30 percent of offices check eligibility because of the high cost of staff time.

If a doctor’s office does not verify eligibility, it may submit a claim to an insurance company for reimbursement, only to have it denied because of incorrect information or the patient has not met his/her deductible. The office must now use valuable resources to track down the correct information to collect payment.

Verifying eligibility before an appointment is not an effective solution either. First, in the current method of batching, a staff member is still required to correct errors and to contact patients to correct them. Errors could occur because of incorrect information or the patient is no longer eligible. Second, a patient’s eligibility at the time of service may be different; the remaining deductible may have changed or the patient may no longer be eligible.

Because there is more pressure to determine a person’s remaining deductible at the time of service, 70 percent of doctors’ offices will have to facilitate a process change. For the 30 percent of offices that do verify eligibility, they will have to look for new ways to eliminate the high costs associated with the current process.

Clearwave is the most effective solution for eligibility verification. Through the Clearwave system, patients – rather than the front desk staff – check their eligibility at the time of service. Doctors are now able to grow their practice without hiring more front desk staff so that they can focus on patient care.