Many payment delays in healthcare stem not from billing errors but from issues during insurance verification. When verification errors slip through, the result is often claim denials, payment delays, or lost revenue. These issues are persistent and add up to chaos later on.
Below we will walk you through key mistakes that silently disrupt revenue cycles across your practice and how you can prevent them.
Verification Errors that Healthcare Practices should Avoid
1. Assuming Coverage Is Active
Coverage can lapse, change, or shift providers. Yet, many front-desk teams may assume the patient’s card tells the full story. If they don’t verify on the payer portal on the same day as the appointment, that assumption can cost you.
What to do: Check eligibility each time a patient’s visit is scheduled. Don’t rely on past visits or cards. Real-time checks can reduce rework and unpaid claims.
2. Verifying the Wrong Policy Type
Not every insurance plan covers the services your practice offers. Out-of-network benefits, referral requirements, and coverage limitations can all block payment.
For example, a patient may carry a PPO plan, but that plan may need pre-approval for a routine procedure. If your team doesn’t confirm the type and scope of coverage, the claim settlement can be delayed.
What to do: Verify both the type of coverage and the specific benefits tied to the service. Don’t assume “active” means “approved.”
3. Overlooking Secondary Insurance
Many patients have more than one insurance plan and without clear coordination of benefits (COB), providers may bill the wrong payer first, and it may cause long delays.
COB mismatches also increase write-offs when patients are incorrectly held responsible for balances which they don’t owe.
What to do: Ask every patient if they have secondary coverage. Collect that information up front and confirm the order of responsibility.
4. Missing Authorization Triggers
Some plans require pre-authorizations not just for surgeries, but also for imaging, therapies, and medications. Failing to identify these triggers during verification is one of the top reasons for claim rejections.
What to do: Use payer-specific rules to flag when authorization is needed. Build your verification workflow to catch this early, ideally before the patient walks in.
5. Ignoring Policy Effective Dates
Active coverage doesn’t always mean the service date falls within the covered period. Short lapses, plan changes, or retroactive enrollments often go unnoticed, until there is a denial.
What to do: Always confirm the effective start and end date of the policy—not just that the policy is “active.”
6. Failing to Capture Patient Responsibility
High-deductible plans and coinsurance models mean patients often carry a large portion of the bill. If your staff skips the eligibility check or doesn’t review the patient’s cost-sharing details, your team may miss the chance to collect up front.
What to do: Provide clear estimates of patient responsibility at the time of scheduling or check-in. Educate your team to communicate this calmly and accurately.
7. Lack of Documentation
Even if the eligibility check was done but has not been documented, it would be considered pending or not done (as far as audits or appeals are concerned).
What to do: Keep a digital or printed copy of each verification, including date, time, source, and staff name. This protects your practice and supports appeal cases if needed.
Final Thoughts
Revenue cycle performance depends on the quality of your front-end processes. Eligibility verification is one of the most critical but overlooked steps. A consistent, documented, and payer-aware approach limits downstream issues and supports better financial outcomes with fewer manual corrections.
If insurance verification is creating challenges in your revenue cycle, IDS Healthcare can help simplify the process and improve outcomes across your front-end operations.