How Poor Insurance Verification Reduces Profits for Cardiology Practices

By Chloe From Clearwave | July 22, 2024

In the world of cardiac care, cardiology practices are grappling with a myriad of obstacles to maintain their financial health. While many factors contribute to a practice’s bottom line, one critical yet often underestimated element is the accuracy and efficiency of insurance verification processes. Less-than-optimal insurance verification can erode profits and lead to increases in cardiology practice claim rejections. Keep reading to explore effective strategies for reducing claim rejections and increasing co-pay collection at your cardiology practice.

The Hidden Costs of Ineffective Insurance Verification

Inefficient insurance verification processes can have far-reaching consequences for cardiology practices, impacting everything from co-pay collections to daily operations, long-term financial stability and more. Here are two critical areas where these hidden costs manifest.

Time and Resource Drain

Cardiology practices often find themselves trapped in a cycle of manual insurance verification processes. This approach is not only time-consuming but also prone to human error. Staff members may spend hours on the phone with insurance companies, navigating complex phone trees and long hold times. This tedious process diverts valuable resources from patient care and other critical tasks. Even cardiology practices that leverage some form of automated insurance verification can still see time and efficiency drains, depending on the solution they use. After all, not all insurance verification technology is purpose-built to reduce staff workloads. See the difference a mulit-factor eligibility solution can make.

The time spent on insurance verification can create bottlenecks in patient intake. As waiting rooms fill up and appointment times get pushed back, patient satisfaction suffers. In an era where 73% of patients maintain a “mental scorecard” of their experiences with a new doctor’s office, such inefficiencies can have lasting impacts on patient retention and practice reputation.

Increased Claim Rejections in Cardiology

The most financially damaging consequences of poor insurance verification are an increased rate of claim rejections and an inability to collect accurate co-pays at check-in. Cardiology practices deal with complex procedures and treatments that often come with hefty price tags. When insurance information is incorrectly verified, outdated or patient demographic information is not correct, practices face a higher likelihood of claim rejections, stalling the billing cycle and impacting time in AR. 

Compounding these issues, cardiology practices often struggle with nuanced insurance verification challenges. These include detecting inactive insurance policies, identifying discrepancies with other payers on file, verifying Medicare coverage and catching mismatched patient names. These oversights can lead to severely delayed payments, low co-pay collection rates and increased administrative workload. 

For instance, without up-to-date and thorough verification, practices may miss that it’s been replaced by a different policy or that Medicare has become the primary coverage. These seemingly minor details can have major implications for claim approvals and timely reimbursements, further straining the practice’s financial health. When staff have to go patient by patient to thoroughly review insurance, they often won’t have time to catch these nuances or solve them prior to patient appointments. Even with automated verification solutions provided by practice management systems, that patient-by-patient process can still slow down critical pre-appointment insurance-related tasks.

Beyond missing the ability to collect co-pays prior to rendering care, claim rejections caused by poor insurance verification will set off a chain reaction of additional work and delayed payments. Billing staff must spend time investigating the reason for the rejection, correcting the information, and resubmitting the claim. This process not only delays reimbursement but also increases the chances of the claim exceeding timely filing limits, potentially resulting in lost revenue. 

For cardiology practices, where procedures can range from routine stress tests to complex interventional procedures, reducing claim rejections is crucial for maintaining financial stability. Each rejected claim represents not just a delay in payment but also additional administrative costs and the risk of non-payment if the issue isn’t resolved promptly. By addressing these hidden costs, cardiology practices can significantly improve their operational efficiency and financial health, and even decrease claim rejection rates by 100%

Where Time and Money Are Lost in the Revenue Cycle

Understanding where time and money are lost is crucial for identifying opportunities to improve financial performance. 

Point-of-Service Challenges

Without an efficient system to verify insurance in real-time, cardiology practices often struggle to increase cardiology co-pay collection and collect accurate co-pays at the time of service. This leads to:

• Missed opportunities for immediate co-pay  collection
• Increased administrative work to bill patients later
• Higher risk of non-payment as time passes

Post-Service Revenue Leakage

Poor insurance verification can have a ripple effect throughout the entire revenue cycle:

• Administrative staff spend extra time resubmitting claims
• The practice incurs additional costs associated with resubmissions
• Outstanding payments grow while physicians go unpaid for services rendered

The Impact on Cardiology Practice Profitability

The consequences of ineffective insurance verification go beyond day-to-day operational hiccups, directly affecting a cardiology practice’s bottom line, including:

• Missed opportunities to collect payments prior to offering care, increasing write-offs
• Prior authentication disruptions due to incorrect insurance, causes profit loss
• Incorrect co-pay amounts collected at check-in increases credit and debt challenges

The Solution to Increase Cardiology Co-pay Collection and Reduce Claim Rejections

To combat the challenges of inefficient insurance verification, forward-thinking cardiology practices are embracing innovative solutions like Multi-Factor Eligibility™ Verification. This advanced automated system goes beyond traditional verification methods, offering a comprehensive approach to reduce claim rejections, increase co-pay collection and minimize claim rejections for cardiology practices — all throughout the patient journey.

Multi-Factor Eligibility™ Verification stands out from the automated solutions offered by your PMS, because it conducts multiple checks on each patient, verifying coverage at every critical interaction point, from scheduling to check-in and beyond. These checks provide real-time, up-to-date insurance data, significantly reducing errors and accelerating the billing process — all while reducing staff workloads.

By implementing this cutting-edge solution, cardiology practices can expect:

• Fee free eligibility checks that capture the most current patient insurance status and require minimal-to-no staff work
• Accurate and instant co-pay determinations  available immediately at the check-in
• Dramatically reduced administrative burden on staff, freeing them to focus on patient care and other administrative responsibilities
• Minimized risk of claim rejections due to outdated or incorrect insurance information
• Improved cash flow through accelerated billing and collection processes

Practices have achieved a 100% reduction in claims rejections by using a solution that offers Multi-Factor Eligibility™.  This tool represents a strategic investment in a practice’s financial health. 

The Path Forward for Cardiology Practices

By addressing insurance verification inefficiencies, cardiology practices can:

• Reduce claim rejections
• Increase point-of-service collections
• Minimize bad debt accumulation
• Improve overall profitability

Investing in robust insurance verification processes is not just about reducing administrative headaches—it’s a strategic move to secure the financial future of your cardiology practice in an increasingly challenging healthcare environment. 

Ready to transform your cardiology practice’s financial health? Learn from industry leaders who’ve successfully tackled these challenges. See how Annapolis Neurology drives consistent co-pay collections with fewer staff.