All Eligibility and Benefits Verifications

Eligibility and Benefits Verification Companies in Texas

It is frustrating to provide treatment to the patient but then find out later that the work indeed is not covered by the insurance. The result: denial of claims, disappointed patients, and losses. Such situations could easily happen in many cases where practices do not have any system for verifying patient eligibility and benefits before appointments.

One thing clear to every doctor in Texas is that the complexity of insurance policy goes beyond that. Every payer comes with a set of rules that are in and out of their coverage, deductibles, and even pre-authorizations one has to constantly keep up with. This is basically the role that Eligibility and Benefits Verification companies in Texas come in- validation of coverage details for each patient before they even step into your office and so much more.

But then, why should you even bother to outsource this process instead of doing it in-house? And how does one arrive at the choice of the right company in Texas? It is best broken down into points.

Table of Contents

What is Eligibility and Benefits Verification?

So before really delving into the advantages of outsourcing, let us just clarify what, exactly, E&B verification is.

Eligibility and Benefits Verification is performed prior to a patient appointment to verify insurance coverage. It includes:

Whether patient insurance is active
Services covered and limitations
Applicable co-pays, deductibles, and out-of-pocket costs
Pre-authorization requirements for certain procedures

Not completing this step usually results in either rejection of claims or delayed payment with possible bill disputing. Thus, every practice should set up a reliable structure to be able to work properly.

In-House Verification Challenges

A lot of practices want to take care of their own eligibility and benefits verification. While this may seem like a cost-effective way, it more often creates problems than it solves. Here’s why:

Time-Consuming

Insurance verification involves endless phone calls and portal logins, coupled with long waiting times. Your front desk staff can be quite busy handling patient scheduling, check-ins, and paperwork, so they probably have very little time to devote to E&B verifications at this time.

High Risk of Errors

Insurance details change rapidly, and these changes may occur during the verification process. A small mistake while verifying benefits, such as forgetting to check for pre-authorization, may cause the claim to be denied. An appeal to that claim wastes precious time and resources, and in many cases, denied time means lost revenue.

Delays in Patient Care

Maybe the patient comes and gets an appointment for the service, but their insurance verification is not done, so your staff starts to scramble to verify at the last minute. There will be much waiting and rescheduling and much frustration for your staff and the patient alike.

Lost Revenue Due to Unpaid Claims

It’s not just more work when a claim is denied; they mean you’ve lost money. A patient may deny paying out of pocket unaware that his insurance does not cover a given procedure. The loss is then absorbed by the practice due to improper verification.

It is certainly a gamble to manage eligibility and verification for benefits in-house. Is it any wonder then that many doctors in Texas work with specialized companies that handle all of this labor quite well?

Benefits of Outsourcing Eligibility and Benefits Verification

Having talked about the obstacles of doing verification in-house, let us now discuss some of the ways in which outsourcing will change the game for your practice.

Speedier Patient Eligibility and Benefits Verification

Companies that do eligibility and benefits verification have dedicated teams for this. They have access to payer databases, direct connections with insurance providers, and automated tools for fast and accurate verification. Therefore, fewer errors and quicker approvals are guaranteed.

Decreased Administrative Burden

Your front desk staff has enough to do already. With E&B verification being handled outside of your office, your front desk can now concentrate on improving the patients’ experience—taking calls, scheduling appointments, and facilitating check-ins—while the outside experts handle the insurance verification.

More Revenue and Less Denials

The fact is that outsourcing will help eliminate denials due to erroneous or missing insurance information. Claims get paid more easily, appeals are lessened and so your practice is healthier.

Enhanced Patient Satisfaction

Patients hate surprises when it comes to billing. Knowing, beforehand, what their insurance would cover allows them to anticipate an exact cost, thus adding to trust and enriching patients’ experiences.

Insurance Regulations Compliance

Insurance rules and policies change frequently. Keeping up with these changes can be overwhelming for a medical practice. E&B verification companies ensure that they keep abreast of payer policies to remain compliant and minimize the risk of claim rejection.

Choosing the Right Eligibility and Benefits Verification Company in Texas

Now that you’ve decided that outsourcing E&B verification is the right choice for your practice, selecting a company that matches your practice needs is the next step. Here are some critical points to consider:

Healthcare-Related Experience

Look for a company specializing in medical billing and eligibility verification. A provider that has experience working with practices in Texas should be well versed in the local insurance payers and their individual requirements.

Accuracy and Turnaround Time

What is the company’s verification process? What is their turnaround time for checking patient eligibility? Do they have automated tools to decrease possible human errors? Speedy and accurate verifications are very critical so that your practice runs smoothly.

Integration with Your Existing Systems

It should work with your existing systems for electronic health records (EHR) and practice management. This will facilitate workflow and decrease the need for manual data entry.

HIPAA Compliance

Patient data security is not negotiable. Make sure the company abides by HIPAA and has other robust measures for data protection.

Customer Support and Communication

A true E&B verification partner would boast stellar customer support. When problems arise, you require a team that will take the initiative in resolving them.

Why Practolytics is the Right Fit for You

Practolytics understands what Texas doctors have to go through concerning eligibility and benefits verification. That is why we provide fast, accurate, no-strings-attached verification services so that your practice can run efficiently.

We help you reduce denied claims, ensure quick payment, and build a great patient experience with real-time verification, seamless EHR integration, and insurance professionals who stay in the know.

Let us take the weight off your shoulders so that you can focus more on what really matters: your patients.

Want to speed up your eligibility and benefits verification? Contact Practolytics today!