It is estimated that about 25% of all submitted claims are denied on first pass to the insurance carrier. Furthermore, it is estimated that about 1/3 of these denials are a result of the patient not having active coverage, or some other piece of information that one can obtain from an eligibility check. Therefore, about 8% of all claims are denied for not having accurate eligibility information at the time of submission
No insurance eligibility verification? How much is this costing your practice?
For this example, let's look at a typical radiology practice:
- A 5 radiologist practice will perform about 75,000 studies per year, or about 300 per day
- The average radiology claim is about $200
- About 25 claims (8%) will be denied each day because of insurance eligibility problems
- This translates into about $5000 in denied claims per day
- These denials are costly to rework and resubmit
It clearly makes sense to verify patient eligibility!