Eligibility Verification

Patient eligibility is one of the important challenges facing providers today. Most providers complete only as many eligibility verifications as their staff have time for 1-800 phone calls. The eligibility of half or more of all patients is typically not known until receipt of an EOB weeks after the date of service. Approximately 6% of all claims are denied due to ineligibility and less than 50% of patient pay receivables are collected.

RevenueMD solves this problem by delivering critical eligibility data to your desktop in a matter of seconds using a standard web browser. This allows you to collect appropriate funds from both patient and payor or make financial arrangements before service is rendered.

RevenueMD Features:

• All-payor real-time access from a single secure website

• User-friendly interface presents eligibility responses in plain English

• Single patient or batch requests; standalone or POMIS integrated

• Optional ELSEE™  Eligibility Search Engine™ searches multiple likely payors for eligibility when supplied info is invalid

RevenueMD eliminates

• Waiting on hold for verifications

• Accessing multiple payor websites for verification

• Eligibility-related financial losses

RevenueMD Eligibility Engine
When a patient’s payor information is invalid, often this is simply a result of an outdated patient file, errors in supplied information, new carrier due to a change of employment or other reason. ELSEE is RevenueMD’s proprietary eligibility search engine that attempts to find valid eligibility from the payors most likely to provide coverage for that patient based on regional and other factors. A substantial percentage of problem cases can be converted using this tool. ELSEE can reduce the need to contact patients for insurance information, minimize staff time and financial losses.

• As a web-based services company, RevenueMD offers many benefits that are not commonly found in other practice management and Electronic Medical Record (EMR) software solutions, including:

• Proprietary payer knowledge, including the largest real-time database of payer rules and regulations in the industry (updated constantly and shared by all clients)

• Ability to prevent denials by writing rules specifically designed for each practice

• Ability to identify noncompliant payer behavior, including violation of prompt payment statutes

• Ability to compare financial performance of individual areas within a practice and to benchmark performance against other practices

• RevenueMD’s new clinical offering that applies the same powerful combination of intuitive software, billing intelligence, and results-oriented services found in RevenueMD’s practice management services to a next generation EMR service.