An Action Plan To Improve Eligibility Verification

December 14, 2023 | 3 min read

Nobody likes to receive surprise bills from their dentists. But that’s hardly just your patients’ problem. If handled poorly, the situation can lead to a frustrating patient experience, increase your administrative burden, lower your revenue, impact patient retention, and tarnish your reputation.

“Patients with coverage may not expect to get a bill after the fact, and this uncomfortable situation may mean your practice is stuck writing off collections for treatments performed.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper.

Do you have an eligibility verification process to support dental revenue cycle management (RCM)? If you do, are you getting the most out of your resources? Here’s a 5-step action plan to help you maximize its cost-efficiency.

1. Evaluate Your Current Eligibility Verification Process

Take stock of whether and how your practice verifies eligibility by assessing the current method and identifying its strengths and weaknesses. How does your staff collect and verify information for each patient? What tools do you use, and is there a standardized procedure? 

Evaluate the effectiveness of the technology you use for eligibility verification — does it provide real-time information, integrate with your dental practice management software (PMS), and offer user-friendly features to maximize staff productivity? 

Collect staff feedback to understand the challenges they face and areas for improvement. Also, evaluate accuracy rates of past eligibility verifications by analyzing instances of claim denials or billing errors related to eligibility issues to identify patterns or recurring issues.

2. Calculate Time Required For Eligibility Verification

Conduct a time study to see how long your team spends on eligibility verification. Select a representative sample of staff members who regularly verify patient eligibility. Have participants track the time spent on each step of the process and calculate the average time for each step.

Alternatively, you may conduct a poll using an application that enables seamless collection and analysis of survey data. You should ensure anonymity to encourage honest responses. Review the survey results to understand the average time required for each task and identify trends.

3. Assess the Effectiveness of Your Eligibility Verification Process

Compare the time spent on eligibility verification with the number of claim denials for issues your team could have identified in the patient’s benefits details. First, aggregate the results from your time study or staff polling for the period chosen for analysis. Then, retrieve data on claim denials from your billing or claims management system.

Identify denials related to issues you could have prevented with eligibility verification. Determine the connection between the time spent on eligibility verification and the specific errors leading to claim denials. For example, do longer verification times correlate with a reduction in denials?

An integrated, cloud-based dental PMS like tab32 offers a robust billing module to help you track and analyze claims efficiently. Plus, you can see claims from all locations in one place to gain a holistic view of your billing practice.

4. Determine Whether to Insource or Outsource Eligibility Checks

Using the learnings from the study and analysis, you can decide if you should keep your eligibility verification process in-house or outsource it to a third party. Calculate the total costs of insourcing (e.g., staff salary, training, and technology expenses) and compare them with quotes from reputable external providers.

Besides expenses, consider factors like scalability, accuracy, and consistency of your options. Compare turnaround time and assess if the benefits of faster verification outweighs the added costs. Also, see if your practice requires a high degree of control over the process (which may require keeping it in-house) or if outsourcing offers sufficient customization to meet your needs.

5. Design Standard Operating Procedures (SOPs)

Whether you decide to insource or outsource eligibility verification, your next step is to design a process and SOPs for your staff or third-party service provider to check benefits in a consistent and timely manner. 

Your SOPs should define the objectives of your eligibility verification process (e.g., reduce claim denials, improve accuracy, and enhance the patient experience) and identify key stakeholders involved. The SOPs should also include a step-by-step workflow with clearly defined tasks for each stage (e.g., data collection, contacting insurance providers, and documenting verification details.)

Also, define a timeframe for completing eligibility verification to ensure timely and efficient processes. Additionally, integrate quality control measures, such as spot checks and regular audits, to catch and correct errors.

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Ready to master revenue cycle management? Get The Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper. 

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