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Thursday, 20 June 2013 08:18

Saving Time and Money through Real-Time Eligibility Featured

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post49 picI have previously posted about the value of electronic transactions between the dental office and their insurance payers

I spoke in general about the top transactions in this post, and got more specific with the value of the electronic remittance advice with this post

This week I will get specific with the real-time eligibility transaction.  The appropriate use of this transaction can save your office time and money.

Let me start by providing a definition. 

Real-time eligibility verifies a patient’s coverage status with their insurance company and returns certain important properties of that coverage

If your practice management software provides this capability, it can often be done through the push of a single button.


Here’s a screen shot of how we’ve integrated a real-time eligibility button into our appointment screen for a specific patient.


Saving Time
How do you verify eligibility today?  A time-consuming phone call?  Maybe the website provided by the insurance company

Both of these methods take precious minutes from your staff.  When was the last time you called an insurance company and did not spend time on hold? 

If your office is busy and some administrative duty occasionally needs to be skipped, verifying eligibility may be high on that list.  

The electronic eligibility transaction is required to be completed within 20 seconds.  That’s 20 seconds between the time you request it to the time the response is on your screen. 

My experience has been that the transaction generally takes around 10 seconds but this will vary by insurance company.

Saving Money

According to a study done by the AMA, 25% of claims denied by insurance companies are done so because the patient is not eligible.  Have you had some claims that contributed to that statistic?  These could be avoided with the real-time eligibility transaction.  

The eligibility verification transaction also provides benefit information that can include deductible and copay data.  This allows you to collect the patient portion of the charges at the time of service improving your cash flow and reducing billing and collection costs.  

The same AMA study estimates that you could save as much as $3700/year by faithfully verifying a patient’s eligibility.  Here is a link to that study.  It’s rather lengthy, but an educational read if you are responsible for collections in your dental practice.  

If you only verify the eligibility of new patients, you may want to re-think this approach.  Employers may change insurance plans frequently or may offer an opportunity to their employees to change their plan options. 

Changes with healthcare reform will have employers and employees re-considering how or if dental benefits will continue. 

Verifying the coverage of even long-term patients will increasingly become necessary.  Right Click Dentistry provided a good 3-part series on the potential impact healthcare reform might have on the dental practice.  Here’s a link.  

How to Use Real-Time Eligibility

With the ability to verify eligibility a button-push and perhaps 10 seconds away, I would recommend using it in this manner.

  1. Verify the eligibility when the appointment is made.  This is particularly true for a new patient.  If they are making the appointment over the phone, you can do this while an appointment date and time are being discussed.  You can verify that you have the correct information (new patients can make mistakes) and, if necessary, deal with the payment method before they are sitting in your waiting room.
  2. Verify the eligibility again the day before or the day of the service.  Things can changes and knowing this upfront will allow you to deal with these changes before the service is rendered.
  3. Save the eligibility responses from each of these inquiries in the patient’s file.  If there is a claims dispute with the carrier, this information will be helpful in resolving the issue.

Fully using the suite of electronic transactions that are available to your dental practice will greatly benefit your office.  Everyone should be submitting claims electronically.  The electronic remittance advice will speed up posting while eliminating errors. 

Used conscientiously, the real-time eligibility verification saves time and money.  How could these be anything but a right click?

Read 4295 times Last modified on Thursday, 20 June 2013 09:40
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