How to Evaluate Claim Lifecycles to Maximize Revenue: Part 1

A patient sits with his doctor to review a pre-appointment checklist.
A patient sits with his doctor to review a pre-appointment checklist.

Taking advantage of every revenue opportunity is key to the success of healthcare organizations. In order to do this, organizations must closely examine each stage of the patient claim lifecycle to determine where these opportunities exist. Using a combination of intuitive processes and the right technology is essential to doing this in the most efficient manner to increase profitability.

The best-case scenario is when a patient can make both educated decisions about where to receive care and understand their costs, financial responsibility, and insurance eligibility up front. Optimizing operations, reducing costs to collect, and better engaging patients in the financial aspects of their care help lead to a more positive patient experience. That’s why it’s important to evaluate every step in the claims process.

In part one of this series we will explore the pre-appointment stage of the claim lifecycle.


The rise of healthcare consumerism has led to people becoming more informed when making decisions about their healthcare experience. Now, patients want to feel empowered to manage the financial aspects of their care. They can do this more easily when provided access to transparent pricing and accurate estimates of out of pocket costs in advance of service.

This is not only a best practice but is federally mandated through the new price transparency requirements. In order to comply with the mandate and provide a positive experience for patients, practices should provide a patient-facing estimation tool on their website to allow patients to get a clear understanding of their out of pocket costs.


evaluating the front end of the healthcare claim lifecycle by looking at the patient pre-registration process.

Front-end revenue cycle process errors cause about half of claim denials. Of these, over one in four are due to registration errors. Ensuring all information is right the first time prevents rework down the road, saving time and money. Engaging and educating patients prior to them even stepping foot in the office goes a long way in preventing these errors.

Verifying insurance eligibility prior to an appointment allows practices to accurately charge for visits and inform patients of their upcoming financial responsibility. When patients are informed of their estimates prior to appointments, they are more likely to not only come to the appointment, but also be more prepared to pay for services.

Because insurance information is confusing for patients and changes rapidly, it is important to check eligibility as soon as possible so that patients get the information they need. Consequently, this avoids blindsiding patients with surprisingly large medical bills. Another benefit of checking eligibility in advance is that it protects practices in cases where a patient’s insurance has lapsed or when policies don’t cover a certain procedure.

Some practices still rely on manual insurance verification. The process can be time consuming and also leads to human error. Switching to electronic patient verification methods can save a practice time and money. The key is to find a solution that allows for an exception-based workflow, which allows staff to focus only on patients whose insurance verification needs attention.

If you liked this article, be sure to read part two and part three of this series where we cover the appointment stage and the post-appointment stage of the healthcare claim lifecycle.

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