Eliminate claim rejections and realize more revenue: A step-by-step guide
A simple protocol that helps practice office staff collect and verify insurance information accurately every time.
At a Glance
- A structured, 3-stage insurance verification process (pre-visit, during visit, and post-visit) is crucial for healthcare practices to maintain consistent revenue cycles and reduce claim rejections.
- Regularly auditing verification procedures help practices identify workflow gaps and improve efficiency, ultimately streamlining billing cycles and reducing administrative burden on staff.
- Proactive eligibility verification before patient visits enables practices to correct errors early, communicate costs clearly to patients, and avoid surprise bills — contributing to better cash flow and patient experience.
Effective insurance verification ensures healthcare practices are billing payers correctly, reducing unnecessary claim rejections. Missing or inaccurate information can disrupt the billing process, creating hurdles that impact practice operations and cash flow. Rejections delay payments, requiring office staff to conduct follow-ups, make corrections, and resubmit each claim. These interruptions take valuable staff time away from other essential tasks, and rejected claims can lead to inconvenience and unexpected bills for patients, affecting their experience with the practice.
“Missing or inaccurate information can disrupt the billing process, creating hurdles that impact practice operations and cash flow.”
To minimize errors and avoid information gaps, independent practices can develop a structured verification process that integrates with staff workflows. Medical billing companies can also help their practice clients implement clear verification procedures for each stage of the visit — before, during, and after the patient’s appointment.
This step-by-step guide outlines a simple protocol that helps office staff collect and verify insurance information accurately every time.
Before the visit
To lay the foundation for accurate billing and claim submissions, office staff should begin verification during initial scheduling.
Pre-visit verification checklist
- Collect patient demographics when scheduling the appointment. For returning patients, verify that the information has not changed since their last visit. Include:
- Patient name, date of birth, address, and phone number
- Insurance information, including policy and group number
- Primary subscriber name and date of birth
- Remind the patient to bring their insurance card and ID to the appointment.
- Verify eligibility and correct any errors in information provided by the patient. If there is a problem with their coverage, notify the patient and estimate their responsibility.
- If required by the payer, obtain authorizations and referrals.
Verifying eligibility in advance allows staff to correct errors prior to claim processing. It also provides enough time to notify the patient of any out-of-pocket costs or coverage issues before their appointment. Clear communication supports a more positive patient experience in the long run.
During the visit
When the patient checks in for their visit, confirm their information with them directly. This is another opportunity to catch last-minute changes and verify accuracy.
Time-of-visit checklist
- Review patient demographics and insurance verbally.
- Make a copy of the patient’s insurance card and ID. Check to make sure that the copy of the patient’s demographics and insurance on file match the physical cards.
- Verify that eligibility has been run within the last 24–72 hours. If any changes in coverage have occurred, rerun eligibility.
- Validate charges using a claim scrubber before sending them out.
Taking time to double-check details when verifying claims during the appointment ensures that the amounts and codes are entered correctly before submission, preventing delays due to or charge errors or miscoding.
Learn about Tebra’s integrated billing solution for practices.
After the visit
To minimize the risk of missed revenue, ensure that claims are resubmitted within payers’ timelines. Ongoing monitoring of rejection reports helps pinpoint common errors, such as incorrect demographics or mis-entered policy numbers, allowing staff to address such issues proactively.
Post-visit verification steps
- Review rejection reports on a regular basis, including an internal validation report in your practice management system, as well as clearinghouse rejection reports.
- Work rejections immediately to avoid timely filing issues.
- Avoid automatic re-billings of claims that have not been paid.
Staying on top of rejections doesn’t just make revenue cycles more predictable. It also reduces staff workload, limits follow-up requests for additional information, and minimizes surprise patient bills.
Audit the verification process regularly
Maintaining a reliable revenue cycle requires smooth, consistent claims processing. To ensure verification procedures remain integrated with staff workflows and continue to facilitate complete and accurate information collection, practices should conduct routine audits of all steps — before, during, and after the visit. Audits help identify gaps and improve verification efficiency, further streamlining the billing and payment cycle. This in turn continues to reduce staff workloads and minimize delays and unexpected costs for patients.
Tebra’s medical billing platform provides billing companies with tools that systematize workflows to speed up payments, scale growth, and maximize revenue. Read more about how Tebra tailors services to support individual billing companies and the specific needs of their clients.
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