Common Challenges in Benefit Verification and How to Overcome Them

Benefit verification is one of those behind-the-scenes tasks that can make or break your revenue cycle. It ensures that healthcare providers get paid properly for their services by confirming patients’ insurance coverage before care is delivered. However, anyone who’s dealing or ever dealt with benefit verification knows that it’s not always smooth task. From complex insurance policies to slow responses, challenges can pile up quickly and impact the revenue collection

At EZ Settle Solutions, we work closely with healthcare practices to make sure benefit verification is done right, every time.

Before we dive into today’s topic, you might find our article, “How Efficient Benefit Verification Can Improve Revenue Cycle Management,” helpful, as it aligns with this article.

Now lets take a look at some of the common obstacles that can impact this process and sharing simple, easy and practical ways to tackle them. Let’s get started.

1. The Confusion of Complex Insurance Policies

One of the biggest headaches in benefit verification is navigating the sea of different insurance policies. No two policies are exactly alike, and keeping up with the ins and outs of various insurers can feel like an endless task. This complexity often leads to errors—small details get missed, which can result in claim denials or payment delays.

Solution :

• Keep Learning: Continuous education is key. By providing regular training to your staff on the specifics of various insurance plans, you can help them feel more confident and reduce the risk of mistakes. Understanding policy differences—like deductibles, co-pays, and coverage limits—can go a long way in making the process smoother.
• Embrace Technology: Automating the verification process can also be a game-changer. At EZ Settle Solutions, we implement software that quickly pulls up policy details and highlights potential issues, making benefit verification less of a hassle for your team

2. The Frustration of Manual Processes in Benefit Verification

Many practices still rely on manual methods to verify benefits—calling insurance companies, sending faxes, and waiting for responses. These old-school processes are time-consuming and prone to human error, which can slow everything down.

Solution:

• Automate It:  AI and ML technologies automate eligibility checks, analyze large volumes of insurance data, and improve accuracy and efficiency over time.  Automation is your friend here. By switching to electronic verification systems, you can drastically cut down on the time spent on benefit verification. Automated systems can verify coverage instantly, allowing your team to focus on more important tasks.
• Simplify Your Workflow: It’s also worth taking a step back and looking at your current processes. Are there steps you could eliminate or streamline? At EZ Settle Solutions, we help practices evaluate their workflows and make the verification process as simple and efficient as possible.
• Application Programming Interfaces (APIs): APIs facilitate seamless data exchange between providers and insurance companies, eliminating manual data entry and integrating eligibility verification systems into existing EHRs.

3. The Waiting Game with Insurance Responses

Waiting on insurance companies for benefit verification can feel like a never-ending process. Whether it’s sitting on hold during a phone call or waiting for a fax to come through, these delays can slow down your entire billing operation and impact your cash flow.

Solution:

• Verify Early: One simple way to avoid last-minute delays is to start benefit verification as early as possible—ideally when the patient schedules their appointment. This gives you extra time to handle any issues that may come up.
• Mobile applications and patient portals: These platforms allow patients to conveniently access and manage their insurance information, check eligibility, and submit documentation for prior authorization.
• For example , “Cerbo EHR“ allow patients to upload their health ID card. They can also check their co-pays and patient statements. Also in “DrChrono“ , patients can choose if they wish to receive bills virtually or by post. They can pay through their credit cards or a payment plan as well.  “Dendi” allows physicians to send bills electronically with a payment link to patients.
• Go Digital: Opt for real-time verification systems that allow for instant responses from insurers. These electronic systems cut down on the waiting game, allowing you to verify coverage quickly and efficiently.

4. The Risk of Inaccurate Information in Benefit Verification

Relying on outdated or incorrect insurance information can lead to all sorts of problems, from claim denials to unexpected out-of-pocket costs for patients. With insurance policies frequently changing, staying on top of the latest information is crucial.

Solution:

• Stay Updated: Make it a point to regularly update your insurance data and double-check it for accuracy. Whether it’s done in-house or with the help of a partner like EZ Settle Solutions, ensuring that you’re working with current information will save you from headaches down the road.
• Check Your Work: Even with automated systems, it’s a good idea to periodically review your verification processes. Having a second set of eyes on key details can help catch any errors before they cause larger issues.

5. The Communication Gap Between Teams

In many practices, the clinical and billing teams don’t always communicate as well as they could. This lack of communication can create issues during benefit verification. For example, if the clinical team doesn’t know about a pre-authorization requirement, services might be provided without proper coverage, leading to claim denials.

Solution :

• Foster Collaboration: Encouraging better communication between departments can make a big difference. Whether it’s through regular meetings or shared systems, making sure everyone is on the same page helps avoid miscommunication. At EZ Settle Solutions, we work with practices to improve collaboration between teams, ensuring that everyone is aligned and up to date.
• Centralize Information: Using a centralized system where all teams can access the same benefit verification data can also reduce the risk of communication breakdowns. When everyone is working from the same information, it’s easier to ensure nothing falls through the cracks.

Wrapping It Up

Benefit verification doesn’t have to be a source of stress. By addressing common challenges like complex insurance policies, manual processes, and communication gaps, your practice can create a smoother, more efficient system that keeps everything running on track.

At EZ Settle Solutions, we’re here to help you every step of the way. With our tailored solutions and technology-driven approach, we make benefit verification easier, so you can focus on what matters most: providing great care to your patients and keeping your practice financially healthy.

By partnering with EZ Settle Solutions, you’re choosing to streamline your operations, enhance patient satisfaction, and secure long-term success for your practice.

The primary objective of our solutions is to ensure healthcare providers receive rightful compensation for their services, while insurance coding aims to accurately submit medical visits or procedures to insurance companies with the appropriate codes for proper processing.

Talk to our RCM Experts to receive a Free Assessment 346-335-4093 / info@ezsettlesolutions.com