How to Prevent Uncompensated Costs with Insurance Discovery

Many providers find they are always trying to do more with less. In today’s healthcare revenue environment, finding and recovering uncompensated care in hospitals can turn a profit or end up in the red.

Over the last four years, self-pay/uncompensated care revenue loss has continued to climb. Is your organization doing anything differently to change this trend?

Assess Your Current State

The American Hospital Association’s annual survey found that hospitals lost over $745 billion between 2000 and 2020 in uncompensated care costs. Recovering reimbursement is critical to supporting a hospital’s profitability and quality of care. Still, it continues to fall by the wayside for providers of all sizes. 

The COVID-19 pandemic is an extreme but essential example of why hospital finance teams must be prepared well before an expected event or upheaval. Implement systems now to prevent significant future revenue loss without disrupting your hospital’s financial goals.

Legacy systems, manual systems, and paper-based systems can no longer keep up with the demands of an evolving industry. Efficiency and accuracy in billing and coding are crucial and can best be achieved with technology-based solutions. 

Establish Performance Metrics

If it can’t be measured, it can’t be managed. The first step to establishing new solutions for preventing uncompensated care is auditing existing systems. Report out on relevant metrics like:

• Patient Satisfaction
• Percentage of bills paid on time
• Staff turnover
• Total uncompensated care costs
• Days in AR
• Average revenue cycle length

Knowing these numbers provides a baseline against which to measure. From here, teams can determine what’s working, what’s not, and the ultimate impact of any changes.

Upgrading to Technology-Based Solutions

As the patient coverage landscape continues to change – due to COVID-19, Medicaid expansion, high-deductible health insurance plans, and patients rapidly aging into Medicare – providers must effectively handle rising uncompensated care costs that can put their organizations at risk. Recovering reimbursement has never been more critical, and that’s where an insurance discovery vendor can help.

Implementing Effective & Strategic Insurance Discovery Programs

Insurance discovery – the foundation of any good revenue integrity program – helps providers find and collect on self-pay, charity, and bad debt accounts. Finding as much patient insurance coverage as possible, as quickly as possible, can help prevent uncompensated care costs. 

Insurance discovery runs an exhaustive check of government and commercial payors to find active, billable sources of primary, secondary, and even tertiary coverage options for uninsured accounts. This removes administrative burden from staff, who no longer need to manually check every possible payor before sending an account to collections. 

Integrating an automated insurance discovery program and strong pre-service and time-of-service eligibility verification creates a holistic approach to reducing uncompensated care. This program helps minimize overall patient accounts receivable and bad debt write-offs by finding accounts or claims that haven’t been appropriately classified.

Use cases for insurance discovery vary depending on where the patient is in their journey. 

Multi-vendor Insurance Discovery Model

It’s an innovative, responsible business practice for any provider to have a multi-vendor insurance discovery model. Using a vendor for a secondary or even tertiary review positively impacts finding coverage other vendors missed, increasing the chances that you see and recover nearly all uncompensated care coverage. 

Pre-visit Insurance Discovery

For patients with scheduled appointments, hospitals can collect information ahead of time via a patient portal or mail-in forms. Getting this information in advance and running it through an insurance discovery tool can detect and verify coverage before the patient walks through the doors. 

Running a pre-visit insurance check is the potential peak of proactivity against uncompensated care in hospitals. The finance team can do a faster, easier job without the risk of manual error or denied claims. The patient can focus on their health, knowing their bills are covered from the start. 

Routine Coverage Discovery

Insurance discovery can still be helpful if a patient has already received care or reported existing coverage. By running regular performance audits behind existing workflows, hospitals and medical organizations can maximize recoveries in lost revenue due to uncompensated care. 

Build these coverage checks into existing processes to ensure all patients, even those who present with insurance, have a chance to reduce their medical bills. 

Insurance Discovery Solutions Help Mitigate Uncompensated Costs

Office Ally is a healthcare technology company that deploys mission-critical software solutions to healthcare providers. Our tools are used every day by healthcare organizations to simplify administrative workflows, facilitate payments, and recover revenue.

For revenue integrity, Office Ally can find dollars that others have missed. Office Ally’s Insurance Discovery finds previously unidentified Medicare, Medicaid, and commercial claims eligibility – discovering hundreds of millions of dollars otherwise left uncollected each year.

Insurance Discovery has helped providers recover, on average, 10-30% of accounts. The solution includes a user-friendly summary of findings and detailed, customized information based on the type of coverage found. Your report format conveniently gives you all the information you need to bill claims as your next step in recovering payment. You’ll know what is likely to get paid and what isn’t – and be able to prioritize billing accordingly.

To prove our concept yields returns for your organization, Office Ally will run a preliminary assessment for free. We go at risk and are paid based on our performance. We only get paid when you get paid - and we always find missed revenue behind the competition.

Receive a report with results in as little as ten days and rebill claims in as little as 30. Click here to sign up for your free Insurance Discovery Assessment and move confidently into more effective, high-quality revenue recovery efforts.