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Enhancing Healthcare Practices Through Effective Benefit Verification

Patient Experience

Many healthcare practices recognize verifying patients’ insurance information as key to their success. However, this essential step is often thwarted by the complexity of the health insurance landscape and its lack of technological streamlining. With numerous insurers, thousands of plans, and the high likelihood of human error, benefit verification has become inefficient, hindering patients’ access to services.

The Impact of Inefficient Benefit Verification

Inefficient benefit verification impacts almost every function of a practice, from lower conversion and retention rates of new clients to affected cash flow and overall practice health. For behavioral health and physical therapy in particular, prevention at scale is a challenge. It’s time-consuming for administrative teams to perform accurate benefit verification throughout the patient journey, and without a sophisticated technical solution, benefit structures are too complex to easily automate.

Why Current Benefit Verification is Slow and Error-Prone

There are three main reasons why benefit verification is time-consuming for healthcare practices:

  1. Inaccurate Patient Information: Errors like using a preferred vs. legal name, spelling errors, or transposing numbers in the member ID are consistently rejected by payers. Strong verification practices compare patient-provided information with insurance records, requiring significant administrative hours. This leads to data entry errors at intake, causing around 20% of all claim denials.
  2. Complex Insurance Structures: The complexity of benefit structures requires verifiers to have institutional knowledge and experience. Even experienced billers lack the tools needed to handle mental health benefits’ opaque structures, affecting their accuracy and efficiency.
  3. Manual Verification: Many providers attempt to verify benefits through a combination of online portals, EHR solutions, and manual calling, which often takes 30-45 minutes per patient. This results in delays, impacting patients’ decisions and leading to coverage disruptions due to shifting eligibility. Reliance on manual verification overwhelms administrative teams.

Manual benefit checks cannot keep up with patients’ shifting eligibility, causing substantial policy denials and wasted biller time. For example, in a clinic with 10 providers, monitoring insurance eligibility would require two full-time staff members dedicated to verification.

Incorrect Benefit Verification Leads to Negative Outcomes

Poor Patient Sentiment and Conversion: Most patients seeking care need a clear cost estimate. Any barrier to care, like unclear cost estimates, increases the chance of negative experiences or forgoing treatment. Manual systems make accurate and prompt cost estimates difficult, affecting patient care and retention.

Claim Denials and RCM Inefficiencies: Incorrect patient information at intake leads to preventable claim denials. An average of 18% of patients had incorrect information, causing claim denials, revenue cycle management inefficiencies, and collection problems. The healthcare industry average is 45-60 days for Days Sales Outstanding (DSO), but advanced verification systems can reduce this to 8-10 days.

Bridging the Gap with Technology

Patients seeking mental health care have grown accustomed to a lengthy process for verification, booking, and payment. But there is a better way. Financial services companies have embraced technology for quick, frictionless payments. Similarly, verifying insurance eligibility should, and can be just as effortless.

The Role of AI and Machine Learning

Creative applications of technology like AI and Machine Learning can solve the problems of manual patient verification. AI-assisted workflows and flexible API solutions provide accurate eligibility and reliable cost estimates quickly. Nirvana’s AI-assisted verification workflows prioritize urgent tasks and reduce unnecessary manual work, allowing administrative staff to focus on patients’ needs.

The Promise of Benefit Verification Technology

Nirvana leverages AI and ML technologies to revolutionize benefit verification. Nirvana’s solution allows healthcare teams to verify patient information with 94% accuracy. Nirvana enables providers to approve over 3 million sessions monthly with full cost transparency for provider groups like Lifestance, Nystrom & Associates, and Geode Health, alongside EHR partners AdvancedMD.

Nirvana understands that solving the eligibility problem at the very beginning of the patient journey yields successful outcomes down the road. With Nirvana, practices can reduce claim denials, increase revenue, and boost patient sentiment by providing full cost transparency before treatment. By embracing innovative patient benefit verification technologies, practices improve their efficiency, financial health, and patient satisfaction.

Better Systems, Better Care

At Nirvana, we believe that by creating better systems for practices, patients receive better care. Our motto, “Better Systems, Better Care,” reflects our commitment to improving operational efficiencies. Explore Nirvana’s intake, continuous coverage monitoring, and custom solutions to enhance your practice’s efficiency and patient care. For more information visit the Nirvana marketplace page.



Topic: Medical Billing, Patient Experience, Revenue Cycle Management


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