5 Reasons Why Electronic Verification of Benefits Tools Do Not Save You Time or Money
There are several electronic verification of benefits systems these days. Office Ally and WebPT have their own eVOB feature. There is also Availity and other payer portals that provide eligibility information.
In theory this sounds great! As an owner, you may be thinking “How wonderful! We can now get all the information online in less than a minute. No more two hour wait times to talk to a payer representative!”
We wish this were true. There are several reasons why electronic verification of benefits tools do not replace your current eligibility workflow.
1) Not a comprehensive eligibility check
Unfortunately, electronic verification of benefits only contains 70-80% of the information you need to perform an eligibility check for a given patient.
Take Availity for example. In almost all cases, preauthorization status and visits used are not available. You may decide to just ignore these pieces of information and see the patient, but this is risky and may lead to a claim denial.
2) You still have to call
Because you generally don’t get all the information you need from portals or electronic verification of benefits tools, you still have to call. The most painful part of calling is waiting on hold to talk to a live agent. It doesn’t matter if you ask all eligibility questions or 1 question, the call time is going to be roughly the same as the bulk of the time is spent on hold.
3) Inconsistency between electronic verification output and payer calls
There are also a lot of times where there are inconsistencies between what the rep says and what the portals say. A lot of the time the information on the portals is very vague, left up to your interpretation and can therefore be misinterpreted by you. You may interpret it one way where as the insurance company will interpret it another. That is why calling and hearing the payer rep explicitly say the number of visits used or other data point you are trying to collect is the best option.
4) Added costs
While Avality is free, several electronic verification tools like WebPT has a cost associated. Why incur additional costs to get health benefits information online when you stiill have to spend the time and resources to call?
5) Requires you to understand how insurance works
When you use an electronic verification of benefits tool, you need to be able to interpret, analyze and comprehend what the benefits report means. You have to sift through the report to find the service type you want and also know how to read the report. This takes a lot of knowledge and if you don’t have the right training, misinterpreting the eligibility requirements can led to a loss of revenues and increase of uncollectable denials.
For all of these reasons, it is important that you still call the insurance company to verify eligibility of your benefits. Not doing so can lead to more claim denials. We understand that dedicating your time or staff time to eligibility is tough. It is time consuming and requires a certain amount of insurance know how. That is exactly why One Body exists. We focus exclusively on helping your clinic with your eligibility needs. We call the insurance companies for you and provide you with a comprehensive, easy to read report for each patient. Please fill out the contact form below or email us at hello@onebodywellness.com to learn more!