Home Encounter Data Improvement Resources Understanding patient registration and insurance eligibility

Understanding patient registration and insurance eligibility

February 2024

Did you know that almost half of claims denials are caused by errors during the patient registration and insurance verification process? This training covers the different types of health care coverage in California and explains how proactively verifying patient insurance eligibility supports high-quality encounter data generation at health centers.

Author

California Medical Association Physician Services Org (CMA-PSO)

Why use it

Verification of patient information reduces the likelihood of denied claims or rejected encounters. Checking insurance eligibility and member benefits enables proactive collection of patient co-pays and prevents delays in health plan reimbursements. Use this training to help community center staff have a firmer understanding of how eligibility impacts encounter and revenue data and improve workflows at the front-end of the encounter data pathway.

Who it’s for

Health center leadership, including Revenue Cycle Managers and Nurse Supervisors, can use this training presentation to help onboard new staff across reception, front desk, and call center roles.

Key take-aways

Verifying patient information, insurance eligibility and benefits is a critical step in the Revenue Cycle Management process. Health centers can systematically prevent “front-end errors” by following these best practices:

  • Check eligibility at least 48 hours before the visit. Check eligibility EVERY visit. Timely eligibility checks help reduce claim rejections and denials, improving revenue capture for the CHC.
  • Automate as much as you can. Most electronic health records and revenue cycle management systems have electronic eligibility checking functionality – configure your system and train staff on using these features.
  • Every CHC is unique – collaborate with internal stakeholders/staff to create a patient eligibility workflow that is right for your health center.

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

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