How Monthly Insurance Monitoring Prevents Coverage Gaps and Revenue Loss

Insurance coverage can change from month to month. Patients may switch jobs, age into Medicare, or lose Medicaid coverage due to eligibility issues. Moving from one insurance plan to another can lead to coverage gaps that cause unpaid claims. 

Providers should constantly monitor patient rosters to ensure their insurance information is accurate and current. Running an automated monthly check using insurance discovery ensures billing teams have the most current information and enhances denial management efforts.

What Is Monthly Insurance Monitoring?

Monthly insurance monitoring is the act of scanning patient accounts for eligible insurance coverage every 30 days, usually on the first of the month. Accounts are pulled from the provider’s billing database and run through an exhaustive check of government and commercial payers in search of overlooked or undisclosed coverage.

This proactive process ensures billing teams have accurate information before collecting on an account. Tracking coverage changes in real time allows staff to make changes to claims before they are submitted, ultimately reducing denials and avoiding delays.

The Hidden Costs of Coverage Gaps

One of the most obvious costs of coverage gaps is the patient's expense. If a payer cannot cover the cost of the account, that cost is passed onto the patient, who is responsible for settling their bill out of pocket.

However, there are also costs to the provider. Denied claims require staff time and effort to edit and resubmit. According to AHIMA, roughly 60% of denied claims are never resubmitted. These claims often end up written off as bad debt, impacting a provider’s bottom line and financial stability.

The Impact of Medicaid Unwinding

The unwinding of pandemic-era protections has resulted in significant changes to Medicaid enrollment. In April 2023, a record 94 million people were enrolled in Medicaid. Today, that number is down to 79.4 million people. The process is referred to as Medicaid unwinding.

According to a KFF report, approximately 74% of disenrollments were procedural, meaning individuals lost coverage due to incomplete or incorrect paperwork, not because they were ineligible. Medicaid churn became a significant problem as half of all people disenrolled were still eligible but had to wait for bureaucratic holdups to re-obtain coverage.

Monthly insurance monitoring helps providers quickly identify changes related to Medicaid unwinding and guide patients toward alternative coverage options, preventing gaps in care and enhancing revenue recovery.

How Monthly Insurance Monitoring Works

At the beginning of each month, automated insurance monitoring systems run scheduled checks on patient accounts to check for insurance eligibility changes. Two possible outcomes exist: existing data is validated, or new data is flagged.

Continuous Validation of Insurance Data

All patient accounts should be run through this process, even if they have active insurance coverage. Major changes in job status, Medicaid eligibility, and other lifestyle factors can occur within a 30-day window, but billing staff won’t know unless they check. 

Most patient accounts will be validated, meaning their insurance coverage is current, and the hospitals can bill the indicated payers. 

Reporting and Updating Insurance Changes

Insurance monitoring healthcare solutions will flag changes to patient coverage and generate reports highlighting patients with updated coverage details. This enables healthcare providers to reach out to patients proactively, confirm their insurance status, and update records accordingly. 

If monthly insurance monitoring was not conducted, these accounts might not have been billed to the correct payers, resulting in lost revenue. An insurance discovery solution easily prevents this loss.

Benefits of Monthly Insurance Monitoring

Reduce Claim Denials and Revenue Loss

This is the biggest benefit of monthly insurance monitoring. By identifying coverage issues before claims submission, providers can reduce the number of medical claim denials that require their attention and contribute to losses within the revenue cycle.

Avoid Coordination of Benefits Issues

When a patient has multiple sources of coverage, it’s crucial to bill payers in the correct order. Billing teams know this can be a major hassle. Insurance monitoring automatically coordinates benefits for providers, avoiding issues altogether.

Eliminate Manual Rework

When claims are denied, staff must find time to edit and resubmit them. Monthly insurance monitoring helps ensure claims are submitted error-free to the correct payer(s) in the correct order the first time. Automating the process streamlines administrative tasks, allowing billing teams to focus on more strategic initiatives.

Improve Patient Experience

Billing is a big headache and pain point for patients, with major impacts on patient-provider trust. When insurance coverage is accurately verified, patients experience fewer unexpected out-of-pocket costs. When account balances are manageable and include only expected costs, patient satisfaction increases, and people are more willing to return for a repeat visit.

Choosing the Right Insurance Monitoring Solution 

There are two key factors any insurance discovery and monitoring solution should offer.

1. Coverage Across All Payers

An effective insurance monitoring solution should work across all payers, including (but not limited to) commercial insurance, Medicare, and Medicaid. Comprehensive coverage ensures that all patients’ insurance details are consistently updated.

2. Compliance and Data Security

Insurance verification involves sensitive patient data. Choosing a solution that complies with HIPAA regulations and prioritizes data security protects patient information and maintains regulatory compliance.

Prevent Coverage Gaps and Protect Your Revenue with Insurance Discovery

Insurance Discovery from Office Ally identifies patients with active billable insurance coverage on their date of service that was previously unidentified. It goes beyond traditional discovery methods of only the top commercial payers by scanning all commercial, Medicare (including Managed Care) and Medicaid coverage that may have been missed during patient access. Additionally, automated monthly monitoring continuously tracks coverage changes, ensuring providers stay updated on patient eligibility throughout the claims process.

Transform your revenue cycle strategy: Learn more about the power of insurance discovery at multiple points along the cycle with these insurance discovery blogs.