Insurance discovery is the process of finding the commercial and government coverage that’s available to a patient. It’s an essential step in identifying third-party payers the patient may have forgotten or may not even know about, which is necessary to maximize reimbursements.
Optimizing the revenue cycle is of chief concern to hospitals in 2021 and insurance discovery is an important component of that, but it comes with its share of challenges. To protect revenue and avoid leaving money on the table, organizations must overcome these three insurance discovery hurdles.
1. Self-pay and Medicaid accounts are on the rise
In the wake of COVID-19, 70% of healthcare executives say they expect an uptick in self-pay and Medicaid accounts, which will be accompanied by a corresponding drop in commercial reimbursements.
This precarious climate means locating all available coverage — especially unknown coverage — is more important than ever to preserve a strong balance sheet. A robust insurance discovery tool can help you check all of your self-pay accounts for applicable commercial and government payers, which helps you maximize your reimbursement dollars.
2. Uncompensated care is a costly burden
Uncompensated care is a persistent challenge for hospitals around the country, amounting to more than $660 billion since 2000. That figure doesn’t factor in Medicare or Medicaid underpayments, which were estimated at nearly $76 billion in 2019, the most recent year for which data was available. With the number of uninsured Americans rising in recent years, we can only expect the financial burdens of uncompensated care and bad debt to continue to grow.
The good news for healthcare organizations is that government funding is available to cover many uninsured individuals. Finding it, however, requires navigating a complex web of public programs, funding streams and disparate systems. Instead of resorting to write-offs, leverage technology to find all available coverage, not just the first one that shows up. The advanced algorithms of an insurance discovery application can identify hard-to-find billable coverage and turn more of your self-pay accounts into third-party payer claims.
3. Manual coverage searches are time- and labor-intensive
Manually searching for billable coverage hurts your revenue cycle in more ways than one. Up front, it eats up labor hours and places undue stress on administrative employees. On the back end, billing the wrong payer leads to reimbursement delays and denials that increase A/R and intensify the bad debt problem.
Rather than relying on tedious and time-consuming searches by a human staffer, automate the discovery process with a system that can identify primary, secondary and tertiary coverage quickly and accurately. Leverage batch inquiries to find coverage for multiple patients at once so you can confidently bill the right payer the first time and spend less time doing it.
A streamlined insurance discovery solution can help you identify the full scope of available coverage and minimize unpaid accounts. Learn more here.