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Revenue Recovery Solutions to Improve Insurance Discovery

March 26, 2024
Healthcare Solutions for Insurance Discovery

Revenue recovery is the process of recouping revenue that healthcare entities are (rightfully owed) but have not received. Frequently, this occurs due to a lack of coverage or reported coverage for a patient. But lost healthcare revenue that must be recovered can also result from the following:

  • Coding errors
  • Insurance discrepancies
  • Regulation changes
  • Complicated billing procedures
  • Missed or underpaid insurance claims

Finding as much patient insurance coverage as quickly as possible can curve the national trend of growing uncompensated care costs. To remain financially viable, hospitals must capitalize on every opportunity to recoup revenue, and insurance discovery is an easy place to start.

Solutions like insurance discovery boost short-term finances while improving financial health in the long run. Embracing insurance discovery services can optimize revenue streams, improve patient experience and enhance revenue cycle management overall.

Continue reading to learn how your hospital can recover revenue in 2024 with insurance discovery healthcare solutions.

Insurance Discovery & Revenue Recovery: An Important Relationship

Insurance discovery inputs patient accounts and conducts an exhaustive check of government and commercial payors to seek out primary, secondary, and even tertiary sources of coverage. It’s often the first line of defense in revenue recovery. You could turn yourself inside out by manually attempting to look at every coverage possibility or sending an account to collections. However, with insurance discovery, you can simply run a coverage check. 

Strong insurance discovery processes maximize reimbursements by recovering bad debt quickly, ultimately shortening the revenue cycle. While this technique is often reserved for self-pay patients, extending to insured accounts for a more holistic approach to revenue recovery is simple enough. Patients may have unknown secondary or tertiary coverage sources that can cover even more of their medical bills.

A healthy revenue cycle is part of a larger workplace culture. Every team member has a role in a hospital’s financial viability, from front desk staff to behind-the-scenes employees. Each person can easily contribute to revenue recovery efforts with the right tools. 

The Dangers of Not Using Healthcare Solutions for Insurance Discovery

Hospitals are constantly combatting the risk of revenue leakage. Less revenue impacts a hospital’s bottom line, ultimately impacting its quality of care.

Manual processes, or hand-checks for insurance coverage, are rife with human error by the patient and provider. Insurance is confusing and patients can inadvertently provide incorrect details while reporting insurance information. Providers may miss or mix up a single digit. Both these instances can lead to errors in coding or billing. 

An established healthcare solution for insurance discovery removes the chance of human error. Not using one is a missed opportunity to increase reimbursement through insurance coverage, improve revenue streams, and easily counter denials. With a solution in place, patient information can be verified before billing even starts, significantly reducing and often eliminating the potential for errors. 

Navigate Insurance Discovery & Revenue Recovery with Healthcare Solutions

While many hospitals use third-party vendors, the right healthcare solution can keep the process in-house and empower your team to handle everything from intake to billing. Selecting a solution from a crowded marketplace can be tricky, but it helps to know what to look for.

Here’s what a good solution should be able to do for your revenue cycle.

Refine the Patient Intake Process

The revenue cycle is in motion from the moment interaction begins with a patient. Insurance discovery can help ensure the cycle begins smoothly by verifying information and finding coverage upfront.

Claims are shorter and easier to manage when staff can easily find all available coverage automatically. It saves staff the time of manually tracking down inaccuracies and lost revenue later down the road. 

Enhance the Patient Experience for Better Satisfaction

Approximately 14% of Americans report having challenges paying an unexpected medical bill. An estimated 39% would not be able to pay a bill of $400 or more without a loan or other assistance. 

Patients tend to have a better healthcare experience when they know expenses are covered by insurance or how much they will have to pay out of pocket for care. Insurance discovery programs lessen stress for patients by removing the financial burden. With this out of the way, the patient can focus on healing and treatment. 

Better Manage Self-Pay Patients

Self-pay patients can be a difficult group for hospitals to manage. With no apparent payment source, billing teams only have patient information and hope the account can be covered out of pocket. Often, these accounts end up in collections or an elongated billing cycle.

With insurance discovery, hospitals improve self-pay patient management for better revenue recovery by finding coverage immediately. Even better, some financial assistance programs–like Medicaid–last longer and extend coverage to the patient’s entire family. With one insurance discovery search, you can cover more than one person for multiple visits.

Simplify Complex Insurance Processes

Health insurance can be extremely confusing for patients, which, as mentioned above, leaves room for errors. Insurance discovery is a safeguard that validates information and ensures registration is up to date before billing. It removes the mistakes and, as a result, reduces denials and errors. 

Integrated Healthcare Solutions for Optimized Approach

Integrated healthcare solutions can bolster a holistic approach and provide comprehensive insurance discovery. Office Ally offers a multi-faceted approach that helps you meet your financial goals with healthcare solutions for insurance discovery and revenue recovery.

Office Ally’s Insurance Discovery can be paired with other solutions, including our MAPS self-pay patient management software, MAPS-clear portal and Medicare underpayment solution for a robust revenue recovery strategy set up for long-term success. The Insurance Discovery solution can sometimes be integrated with other solutions.

With just a batch file for input, the software will use proprietary algorithms to automate the categorization of data received from your organization, Medicare, Medicaid and other payors. The final output is a file showing which claims should be billed and where.

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 year. With the right suite of technology-based tools, your team no longer needs to waste time and resources sifting through ineligible claims, tracking down patients to settle balances and sending accounts to collections.

Maximize Revenue Recovery with Office Ally’s Specialized Solutions

Revenue recovery requires embracing technology, continuously improving and shifting culture to ensure everyone is on board. Office Ally is a leader in revenue recovery solutions, empowering organizations to reclaim revenue and rebuild their financial foundations.

Our team constantly improves our software tools to keep pace with a shifting industry impacted by policy changes and healthcare trends. To prove the Insurance Discovery concept will yield high returns for your organization, Office Ally offers a free assessment that does not require your team's resources or a heavy IT lift.

Click here to learn more about Office Ally’s Insurance Discovery assessment.

This assessment is a win-win, resulting in one of two outcomes.

  1. Free audit: You receive a free audit to validate that existing workflows and/or vendors perform at the highest level.
  2. Additional revenue: Office Ally finds additional revenue opportunities and prevents further leakage.

Charges are only applied if Insurance Discovery uncovers lost revenue for your organization.

Our insurance discovery solution has helped many healthcare organizations obtain reimbursement and increase revenue. Office Ally is proud to help hospitals and health systems nationwide create a better financial future and, ultimately, enhance patient care.

Sign up for your free Insurance Discovery assessment today.