5 benefits of automating your insurance eligibility verifications

May 17, 2022

Updated from the original, published May 3, 2021

Insurance eligibility verifications and benefit checks are one of the first steps in the healthcare revenue cycle after a patient schedules an appointment. It’s vital to avoid inaccuracies in verifying benefits, because mistakes can lead to denied claims, scheduling problems and a poor experience for the patient.

The process is also costly for medical practices. The spending associated with verifying patient benefits increased by 16% in 2021. According to the CAQH 2021 Index, that’s because new codes and health plan requirements for telemedicine and coverage changes because of COVID-19 job losses led to an increase in humans checking insurance benefits manually.

To avoid inaccuracies and save money and humanpower, it’s more important than ever that revenue leaders leverage artificial intelligence capabilities to automate their insurance eligibility verifications.

The healthcare revenue cycle is a clear candidate for intelligent automation through AI, since it consists of many repetitive, inefficient processes that add significantly to the administrative waste burdening our healthcare system. Employees are bored and burned out, claims are chronically backlogged, and ultimately, this waste hurts the patient experience and the hospital’s bottom line.

Automating eligibility and benefits verifications benefits the entire revenue cycle process by:

1. Reducing claim denials

Denied claims and managing denials are a massive problem for the healthcare industry. They create significant work — often too much to be addressed by employees — which leads to increased patient balances and write-offs. And while most denials are preventable, only about half are recoverable, meaning the best denials management strategy is reducing the denials in the first place. Registration and eligibility are the top reason for claims denials, causing nearly 27% of all denials. When you hand off insurance eligibility verifications to intelligent automation, benefit checks will be done more frequently and accurately than humanly possible — thus eliminating upfront errors and the subsequent denials.

2. Saving employee time 

Another problem posed by today’s manual insurance eligibility checks is the employee time burden. Medical practices could save about 21 minutes per transaction if eligibility and benefit verification were done electronically instead of manually, according to the 2021 CAQH Index. When hospitals deploy artificial intelligence on their eligibility verifications, accuracy is improved while employees are simultaneously freed to focus on other tasks. Not to mention that reducing downstream errors, such as denials, also saves time. Employees can then be shifted to work that requires a human touch, ultimately helping the hospital and reducing employee burnout.

3. Improving the patient experience 

Although it may not seem like it, the healthcare revenue cycle is directly tied to patient satisfaction: Even when patients are satisfied with their clinical care, negative experiences with the billing department may cause frustration and even anger. And since patients are taking on increasing financial responsibility, they need hospital staff to check benefits accurately and explain costs clearly. In fact, 40% of patients said insurance eligibility verification was most in need of updating to a digital format.

When patients are informed last-minute that a procedure or test is not covered by insurance, or they are hit with an unexpected bill, their entire experience is tainted. On the other hand, accurate explanations of benefits and office staff who have time to educate patients on anticipated costs lead to higher patient satisfaction.

4. Accelerating and improving cash flow 

When eligibility and benefits are completely accurate, three things happen to accelerate cash flow: claim denials, patient balances and manual touches are each reduced. Claim denials, even when resubmitted, slow down the time for reimbursement. Accurate benefits verifications ensure patients pay the correct copay at the time of appointment and are not hit with unexpected out-of-pocket charges they are unable to pay — and which can be very difficult to collect on. Satisfied patients are more likely to pay on time and pay the total amount.

Plus, all these manual processes take valuable time: time to check benefits in the first place, time to appeal denied claims and time to chase down payments. Time is money, and this employee time can be redirected to other tasks that improve cash flow, such as working on all the denied claims or following up on patient balances. Over time, health systems may be able to scale back their administrative hiring even while growing as an organization.

5. Connecting your eligibility checks to the Internet of Healthcare and using AI to transform your entire revenue cycle 

Not all eligibility and benefit verification solutions are the same. Simple robotic process automation (RPA) technology will only take you so far. If you are considering automating this workflow, be sure you are looking at the big picture of your revenue cycle. Yes, automating eligibility and benefit verifications brings tangible ROI, but to truly reap the benefits that AI and automation can provide your organization and your revenue cycle, you need to think bigger — and long term. A simple point solution may help with this one step, but over time, piecemeal automations and an accumulation of vendors and solutions will lead to disjointed processes, creating more problems than they solve. In fact, 99% of healthcare executives admit their organization uses multiple systems on at least one process.

Real transformation happens when you scale AI throughout the enterprise. You need a full-service, healthcare-only artificial intelligence company to partner with your health system. Then you can connect your processes into a network of intelligence running throughout your hospitals, delivering value today and setting you up for the future. Today, AI can already tackle your eligibility and benefit verifications, your prior authorizations, your denials management and more. Imagine the possibilities of a fully connected revenue cycle and even a fully connected hospital.

Optimize your revenue cycle and see real results with AI-powered insurance eligibility verifications 

Olive uses proven solutions to deliver meaningful ROI that propels AI’s success in your organization and provides the momentum you need to scale. As a single AI vendor for operational efficiencies, Olive can help you create an AI network in your health system that connects your processes and your existing systems, providing deeper visibility and insights that deliver ongoing improvements.

Find out more about Olive’s Patient Access solutions.