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Eligibility Verification

Ensure accurate and timely verification of patient eligibility to enhance the efficiency of your practice while focusing on delivering excellent care.


Comprehensive Eligibility Verification Services You Can Trust

Patient eligibility verification is the first step in revenue cycle management, allowing medical practices to determine whether a patient is eligible for treatment. This process includes a detailed breakdown of benefits, confirming if the patient's insurance covers the healthcare service, and identifying other benefit options such as copays, deductibles, and coinsurance. Ensuring accurate and timely claims submission is crucial for the financial stability of a medical practice and for delivering uninterrupted patient care.

Accurate eligibility verification helps prevent claim denials and delays, directly impacting the revenue cycle's efficiency. When claims are submitted accurately and promptly, it reduces the administrative burden on healthcare providers and accelerates payment processing. This streamlined approach ensures that medical practices maintain steady cash flow and focus more on delivering quality patient care.

The Crucial Importance of Eligibility Verification

Many physicians and private practices consider eligibility verification a formality, often overshadowed by other steps in the revenue cycle management system. However, mistakes in a patient’s eligibility verification lead to the highest rates of claim denials. These denials are often non-appealable and irreversible, resulting in monetary losses and a negative impact on the practice's reputation.

Factura Medica RCM provides specialized eligibility verification services for all medical specialities across the United States. By outsourcing these services to us, medical practices ensure timely payments and focus on patient care.

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Eligibility Verification
How do Our Experts Ensure Accuracy?

Our professional consultants ensure accuracy through a meticulous and comprehensive process. Here’s how we guarantee precise and timely claims submission:

Detailed Data Collection:

Using advanced software, we verify insurance coverage and benefits in real-time, reducing the risk of errors.

Real-Time Insurance Verification:

Focus on patient care while we handle the complexities of insurance verification and communication.

Benefit Breakdown:

We provide a thorough breakdown of benefits, including copays, deductibles, and coinsurance, to avoid any misunderstandings.

Regular Training:

Our team undergoes regular training to stay updated with the latest insurance policies and verification techniques.

Quality Checks:

We implement multiple quality checks throughout the verification process to ensure accuracy and completeness.

Communication with Insurers:

We maintain direct communication with insurance companies to clarify any discrepancies or issues.

Benefits of Outsourcing Eligibility Verification Services
Reduce Operational Costs:

In-house verification can be expensive. Our affordable services provide a cost-effective alternative.

Avoid Claim Denials:

Outsourcing eligibility verification helps avoid system errors that lead to claim denials.

Scale Your Practice:

Our services offer critical leverage, allowing physicians to scale their practice.

Improve Patient Care:

By streamlining the initial phase of the revenue cycle management, we enable practices to focus on patient care, increasing patient satisfaction.

Our Verification Process Includes:
Receiving Patient Schedules:

We receive patient schedules from clinics, hospitals, or medical providers.

Entering Patient Demographics:

We accurately input the patient's demographic information into our system.

Benefits Breakdown:

We provide a thorough breakdown of benefits, including details from both primary and secondary payers.

Initiating Prior Authorization:

We request and secure approvals for the prescribed treatments.

Updating Revenue Cycle Systems:

We enhance the medical practice’s revenue cycle system with detailed information obtained from payers.

At Factura Medica, we follow a comprehensive process for eligibility verification to accelerate your account receivables cycle. Our experts confirm patient eligibility through detailed benefits breakdowns and obtain required prior authorizations before patient visits. Contact us to learn more about our cost-effective services and how we can help optimize your practice’s revenue cycle management.

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Partner with Factura Medica for seamless eligibility verification services.

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