The Importance of Eligibility Verification and How To Do It Right

December 12, 2023 | 3 min read

Dental insurance is complex, and not all patients understand what their plans cover. While the out-of-pocket expenses are their responsibility, a surprise bill may impact your financial health.

“Knowing what benefits are available to each patient your practice sees is crucial. 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.

So, how do you ensure your patients understand their responsibilities before a visit? Including an eligibility verification process in your workflow is essential for effective dental revenue cycle management (RCM).

What Does Eligibility Verification Entail?

Eligibility verification ensures a patient is covered for a specific dental procedure and understands the treatment’s financial aspects.

The process helps avoid common scenarios that may lead to unexpected bills, such as a lack of communication between patients and staff or changes in insurance coverage without notification. These can lead to disputes and frustrations — negatively impacting patient relationships, patient retention, and your practice’s reputation.

Eligibility verification involves confirming insurance coverage and benefit details, like the insurance provider, policy number, the policy’s effective date, the scope of coverage for various treatments, and limitations and exclusions for specific procedures or conditions.

It also clarifies the annual maximum benefit, as well as deductibles, copayments, or coinsurance the patient may be responsible for, to inform the financial aspects of treatment planning. Some dental procedures may require pre-authorization, and knowing the requirements prevents delays and ensures your practice adheres to insurance guidelines.

An effective eligibility verification process also helps increase billing accuracy, minimizes claim denials, and reduces the administrative costs associated with claim submissions. Meanwhile, transparency fosters patient trust and  improves the patient experience.

Get the action plan to improve your eligibility verification process: The Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper shows you how. 

Eligibility Verification Challenges Dental Practices Face

Eligibility verification involves many components, and your process should address these common pitfalls:

  • Patients may provide incomplete or outdated information.
  • Manual verification processes are time-consuming and error-prone.
  • Limited access to real-time information may impact billing accuracy.
  • Complex insurance plans are sometimes hard to interpret.
  • Inadequate patient communication leads to misunderstanding and frustration.
  • Changes in insurance policies can be challenging to keep up with.
  • Outdated or siloed technology leads to inefficiencies and mistakes.
  • Insufficient staff training or high turnover may result in inconsistent procedures.
  • Unresponsive insurance providers may delay the verification process.

Additionally, practices must balance speed with accuracy — rushing the process may lead to oversights and errors. Yet, an overly cautious approach could result in delays and a poor patient experience. 

How To Implement Effective Eligibility Verification 

Dental practices should proactively raise patient awareness about the benefits of eligibility verification and improve patient communication to encourage transparent discussions about insurance coverage before treatment starts. 

An integrated dental practice management software (PMS) with a robust electronic health record (EHR) component like tab32 gives you real-time access to patient insurance information. It allows dental staff to address insurance-related issues promptly and discuss potential out-of-pocket costs with the patient before treatment.

Also, implement a proactive billing strategy and the right technology to help identify and resolve issues promptly. For example, tab32’s billing module integrates with our EHR and imaging platform. It allows you to submit claims seamlessly and in real-time without the hassle of navigating multiple vendor and payer portals and be notified about issues immediately.

Additionally, use tab32’s patient communication module to automate insurance information updates. For example, you can include a secure e-form in your appointment confirmation email for patients to provide their insurance details before a visit or schedule an annual email reminder for patients to verify their information.

Request a demo to see how tab32 can help you streamline eligibility verification and improve revenue cycle management for dentists.

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