Why is Multi-Factor Insurance Verification Key to Dropping Claim Rejections?

By Chloe From Clearwave | February 5, 2024

Dealing with rising claim rejection rates and slower time-to-payment? Outdated manual insurance verification processes could be to blame. 

Claim rejections often occur due to inefficient eligibility checks, outdated policy details and coverage errors slipping through the cracks. These deficiencies drag down cash flow and frustrate staff forced to solve claim submission errors after the fact. However, by leveraging an automated, multi-factor eligibility™ verification system , practices can minimize rejections and unlock revenue currently trapped in claims limbo.

The High Costs of Manual Verification and Claims Rejections

A manual-only approach to eligibility verification and claims management generates unnecessary expenses across the revenue cycle. Relying on staff to verify coverage and process claims by hand leads to wasted time, accuracy issues, slower reimbursement and more.

Relying solely on manual verification leads to challenges like:

• Loss of hours of staff time, leaving less room to focus on other responsibilities. 
• Higher risk of human error, increasing claim rejections down the line. 
• Uncertainty around what’s owed at check-in, leads to bad debt. 
• Slow check-in processes, increasing patient wait times.  
• Inability to collect co-pays and deductibles due at the time of service. 

These deficiencies in patient eligibility verification and data capture directly translate into higher claim rejection rates downstream and reduced collections. As a result, resubmitting those claim rejections will take up your billing staff’s time, slowing down the reimbursement process and impacting their ability to focus on higher value activities like modifying claims or solving claim denial issues. 

The longer claims sit in rejected status, the higher the risk of impacting provider revenue. Higher time in accounts receivable means more time until payment gets into provider pockets. Though initially rejected claims can ultimately proceed to process, delays may mean missed billing cycles or expiration of submission timeframes, losing out on reimbursement and increasing bad debt and write-offs.

Beyond claim submission issues, with lean staff numbers and low retention rates across the nation, you may not have enough staff to manually verify insurance in time to collect payment before a patient is treated. As a result, your practice will face:

• Inexperienced staff slowing down verification/collection processes
• Reduced ability to collect at the time of service
• Increased investment in training time and costs
• Overburdened and frustrated veteran staff
• Higher overtime for staff
• Higher potential for ongoing churn

What is Automatic Insurance Verification?

Practices have implemented some type of automatic insurance verification to reduce staff efforts and inaccuracies around patient eligibility checks and claim submissions. Yet, not all automatic insurance verification solutions are built one in the same. Most solutions on the market only verify insurance once and produce results in a convoluted way that still requires staff to sift through information to determine eligibility and patient co-pays. When practices only run eligibility once, 3-5 days before a patient appointment, they often face a higher rate of claim rejections due to data errors that were never spotted and corrected before claim submissions. Leading to the challenges we discussed in the previous section.

High-growth practices avoid those challenges by using health insurance verification solutions that offer multi-factor eligibility. They leverage a solution that truly reduces staff involvement in the eligibility verification and ensures they have up-to-date patient information without added fees.

Top-earning practices rely on multi-factor eligibility verification to:

• Get up-to-date patient coverage information prior to each visit
• Reduced claim rejections 
• Speed up collections pre-, during and post-visit
• Improve collection accuracy of patient responsibility due
• Drop staff involvement in insurance verification 

How Real-Time, Multi-Factor Verification Boosts Profits 

Multi-factor insurance eligibility software runs eligibility multiple times on every patient, including on the day of service, and can drill down to the plan level — showing staff only the information relevant to them. This view is what can save staff hours in their day.  

For example, Clearwave’s Multi-factor Eligibility™ runs seven times on average per patient engagement and can be instantly rerun with the click of a button — enabling your practice to always collect accurate payments at the point-of-service and verify insurance information for accuracy during post-service billing. The entire process is run without added fees, meaning you don’t have to pay extra for accurate data — because why should you? 

A solution with multi-factor eligibility™ will run automatically and verify insurance at every critical patient interaction, from scheduling to check-in and beyond, all to ensure coverage has not lapsed and without added fees per transaction. As a result, your practice never has stale insurance data and can spot and correct errors faster, enabling you to collect accurate payments when a patient checks in. The same smart solution can also be used to quickly determine patient insurance information in real time for any post-service billing activities. 

Multi-factor eligibility verification allows practices to transform a previously burdensome process into a streamlined strategy that alleviates stress on employees, enhances patient satisfaction and boosts collections.

With fewer rejections, staff can devote more time to patient experiences and other responsibilities. An eligibility verification solution complete with automatic payer-appointment mapping can input accurate co-pays into patient accounts without staff effort. This extra automated step reduces manual data errors that can lead to claim rejections. By catching errors early, claims can be corrected before impacting revenue. This proactive approach is why practices see 94% fewer rejections.

Get Paid Faster & Boost Profits

Real-time, multi-factor verification is key to minimizing claim rejections. Streamlined verification improves revenue cycle performance through lower overhead costs and faster reimbursement rates. Staff productivity is boosted by truly automating a previously manual process. 

With accurate copays and out-of-pocket costs presented upfront, patients can make payments before services are rendered, ensuring your providers get paid from the get-go.

Removing the manual element in the verification process mitigates the risk of human error. This switch improves the accuracy of insurance information and patient data and leads to reduced claim rejections. Clearwave’s eligibility engine has been shown to drive a potential 94% decrease in insurance claim rejections! Do you want to learn more about multi-factor insurance verification? Schedule a Clearwave demo today!