Turn Self-Pay into Payable Claims: How Insurance Discovery Uncovers Hidden Coverage

Often, patients labeled as self-pay have active but unreported insurance coverage. This coverage usually goes undiscovered due to gaps in patient intake or outdated payer data. These missed opportunities result in millions of dollars in lost revenue for hospitals each year.  

Many self-pay patients have billable insurance, but searching each account manually requires too many resources, and outsourcing to a vendor can be precarious. Fortunately, insurance discovery tools can help you uncover hidden coverage, reducing write-offs and maximizing reimbursement before it’s too late.

How Missing Insurance Coverage Impacts Your Hospital

Missing insurance coverage has several widespread impacts. Patients who can’t afford to pay out-of-pocket costs may suffer from the stress of unnecessary medical bills. They may put off treatments until the last minute, assuming they can’t afford them. Staff, meanwhile, must chase down patient balances through multiple points of contact, ultimately sending them to an internal or third-party collection agency.  

However, the financial impact of missing insurance coverage is the most substantial. When patients are marked as self-pay but actually have coverage, the financial consequences can be significant. Claims go unbilled, revenue is lost, and the hospital often bears the cost of care.

The Material Cost of Misclassified Self-Pay Patients

According to industry estimates, anywhere from 20% to 40% of patients listed as self-pay have billable insurance coverage. That percentage adds up quickly, especially for large hospitals or health systems processing tens of thousands of patient accounts yearly.  

According to the American Hospital Association, uncompensated care costs hit $42 billion in 2020, up from $21 billion in 2000. Per the AHA, “Since 2000, hospitals of all types have provided almost $745 billion in uncompensated care to their patients.” On average, uncompensated care makes up 6.6% of a hospital’s budget. The thin profit margins many hospitals live with make this untenable.  

Definitive Healthcare keeps a running list of U.S. hospitals with the highest total uncompensated care costs. The most recent data shows that the individual hospitals' uncompensated care costs ranged from just under 260 million to over 850 million. Most of the hospitals are in metropolitan areas.

Turn Self-Pay Patients into Revenue

Identifying the appropriate payment source for each patient is critical to the provider’s financial health as uncompensated care continues to grow in the U.S.  

Rather than writing off bad debt or spending valuable staff time chasing on self-pay patient management, hospitals can recover revenue by automatically identifying coverage that already exists. With insurance discovery, what was once considered uncompensated care can now become a payable claim and a reimbursable opportunity.  

Enhance the Billing Process with Insurance Discovery

Insurance discovery finds active billable insurance on self-pay patients, even with limited patient demographic information. Simply run a data file with patient information through an exhaustive check and find available forms of billable insurance in return. It’s an easy way to transform your healthcare billing operations, and can be used at multiple points along the revenue cycle.  

Embed Insurance Discovery in Front-End Workflows

The earlier you catch misclassified coverage, the better. Embedding insurance discovery into your front-end processes (i.e., at registration or during pre-service verification) allows your team to identify active coverage before the bill even goes out. This reduces the need for costly retroactive coverage hunts and rebilling.

Faster Claims Filing & Denial Prevention

Every day counts when it comes to claim filing. Discovering insurance coverage early helps you submit clean claims within timely filing limits, preventing lost reimbursement due to expired deadlines or mislabeled patients. Insurance discovery also improves the quality of claim data, reducing errors and improving first-pass acceptance rates.

Key Features Included with Office Ally’s Insurance Discovery

Office Ally Insurance Discovery enables provider organizations to find funds through intelligent automation. It finds active, billable Medicare, Medicaid, managed care or commercial coverage that was missed or overlooked by existing services.  

By shifting the focus from patients to insurance claims that are active on date of service, Office Ally takes pride in our quality-over-quantity approach. Our focus on quality enables us to eliminate false positives, identify confirmed active coverage from the source of truth and provide white-glove customizations for our end user. More than a service, Insurance Discovery is a key component in any healthcare organization’s revenue integrity program, which is an essential part of staying profitable.  

Office Ally’s Insurance Discovery tool is designed to make uncovering hidden coverage simple, reliable, and scalable via the following healthcare software features:  

• Innovation and intellectual IP: Office Ally’s Insurance Discovery has been honed over years of learning and development and through many cumulative years of team experience.  

• Advanced matching logic: Use demographic and historical patient data to match with insurance records—even when information is incomplete or out-of-date.  

• Proprietary data assets and payer connections: Office Ally has more than 3,000 payer connections with a massive claims database of $250B in claims processed, all part of helping power Insurance Discovery for hospitals.  

• Discover hidden coverage: Proprietary algorithms automate data categorization among client facilities, Medicare, Medicaid, managed care and private insurance, generating a list of only those claims that are confirmed eligible by the payer and have the highest probability of reimbursement.  

• Automated coverage reporting: After scanning batch files sent by providers, Office Ally provides you with an itemized file of potentially billable claims that have active insurance coverage. Insurance Discovery also prioritizes claims in the report, so you can pick and choose what to bill.  

• Seamless integration: Insurance Discovery works with any healthcare solutions you already have in place, ensuring minimal disruption while consistently delivering exceptional results and a seamless experience throughout your partnership.  

• Customizable technology: You know your patients, your services, and your revenue streams better than anyone. Office Ally enables you to use that knowledge by creating customizable workflows that guide the search for potential coverage. Office Ally can enable searches that emphasize facility and patient information, state regulations and payer details.  

• Service and support: Office Ally is not just a provider of cutting-edge solutions like Insurance Discovery; they are a dedicated partner in achieving success. A commitment to superior customer service and unwavering support is woven into the very fabric of Office Ally company culture. Whether you have questions, need guidance or encounter any issues, a team of experts is always on hand to provide you with the support and assistance you need.  

On average, Office Ally’s Insurance Discovery solution helps customers identify and recover 10–30 percent of accounts reviewed, even when running behind other solutions. This tool reduces manual labor and the burden on your patient access team, enabling staff to work smarter, not harder, when handling self-pay management.

Stop Leaving Revenue on the Table

Ready to reduce uncompensated care and strengthen your bottom line? Get a free Office Ally Insurance Discovery assessment. With just a basic file export and limited IT support, this free assessment will find missed coverages by your existing discovery tool.  

This assessment is 100 percent risk-free to the provider. For ongoing services, there is no upfront cost, and you only pay if Office Ally helps you recover revenue. Implementation is simple and results in a complete backend revenue recovery loop with actionable results. With Office Ally, the data and results tell the story.  

Dive in: Get your free Insurance Discovery assessment today and start maximizing your revenue recovery potential.