What does the eligibility verification process help prevent?

The eligibility verification process is a critical step in the healthcare revenue cycle that primarily serves to ensure that patients are indeed eligible for the health benefits provided by their insurance plans before any services are rendered. This process helps in preventing insurance fraud and billing errors by confirming that the patient's insurance is active, covers the services being requested, and that the patient has met any necessary requirements, such as waiting periods or prior authorizations.

When eligibility is verified, healthcare providers can avoid submitting claims for services that are not covered, which can result in rejections or denials. It significantly reduces the risk of billing errors that may occur from incorrect patient information or misunderstandings about coverage. Additionally, by validating the patient's eligibility, providers can deter fraudulent activities, such as providing services to individuals without valid insurance or billing for non-covered services.

The other options, while important aspects of healthcare operations, are not directly impacted by the eligibility verification process in the same way as preventing fraud and billing errors is. For instance, increased hospital visits, pre-existing condition claims, and patient privacy violations pertain to different facets of patient care and regulatory compliance rather than the initial verification of insurance eligibility. Thus, focusing on preventing fraud and billing mistakes aligns closely with the objectives of the eligibility verification process.