What are the consequences of not verifying a patient’s eligibility before billing?

Not verifying a patient’s eligibility before billing can lead to potential claim denials and unpaid services, which is significant in the healthcare billing process. When a patient's eligibility is not confirmed, the healthcare provider risks submitting claims to insurance companies that may not cover the services rendered. This can result in claim denials, where the insurance rejects the claim because the patient was not eligible for coverage at the time of service.

Moreover, if claims are denied, providers may have to pursue the patient directly for payment, which can lead to disputes and dissatisfaction from both the patient and the healthcare practice. As a result, the practice may face cash flow issues, additional administrative costs, and possibly a tarnished reputation in the community.

The process of verifying eligibility is an important step to ensure that services are covered and that providers will receive payment for their services, thus avoiding these negative financial and operational outcomes.