In the intricate world of healthcare billing, missed insurance coverage often equates to lost revenue—especially when patients are already discharged, and traditional coverage discovery efforts have been exhausted. However, with the right tools, this doesn’t have to be the end of the road. By implementing advanced coverage discovery technologies into processes, healthcare providers can recover lost revenue even after discharge, locating forgotten or overlooked insurance coverage that initial checks might have missed.
The Challenge of Missed Coverage
In a perfect world, all insurance information would be captured accurately at the point of care, and claims would be processed without issue. However, the complexity of the healthcare ecosystem can result in gaps. Patient insurance coverage details may be incomplete, incorrect, or unavailable at the moment. When patients are discharged, the window for identifying those missing details shrinks, leaving providers with the risk of bad debt or unpaid claims.
Unfortunately, many revenue cycle management (RCM) vendors and/or internal teams conduct one-time coverage checks before the patient leaves the facility. This process, while thorough, is limited to information available in real-time—meaning if coverage information isn’t available immediately, the opportunity to recover it may be lost. These gaps often result in claim denials, which can be costly and labor-intensive to resolve.
Enter Coverage Discovery Technology
Post-discharge coverage discovery technology provides a much-needed safety net. Unlike traditional systems, these solutions continuously scour public and private data sources to identify coverage that may not have been captured at the time of service. This can include:
- Retroactive Medicaid coverage
- Medicare eligibility
- Secondary or tertiary private insurance policies
- Insurance through employers or dependents
By leveraging cutting-edge algorithms and machine learning, this technology actively seeks out valid coverage information post-discharge, ensuring that no potential source of payment is overlooked.
Benefits of Post-Discharge Coverage Discovery
1. Maximize Reimbursement: Every missed piece of coverage equals lost revenue. With continuous post-discharge discovery, hospitals, and healthcare providers reopen denied claims and resubmit them for payment, recovering revenue that would otherwise be written off as bad debt.
2. Reduce Administrative Burden: Manual follow-up on denied claims is time-consuming and expensive. Automated coverage discovery reduces the time spent on claim resubmissions, freeing up staff to focus on more pressing revenue cycle tasks.
3. Improve Patient Satisfaction: When insurance coverage is identified post-discharge, patients are less burdened with hefty medical bills. By finding this coverage, providers can offer a better financial experience for their patients.
4. Minimize Write-Offs: Without this safety net, healthcare organizations often have no choice but to write off missed coverage as bad debt. By rechecking and capturing missed coverage after the discharge, they can minimize these financial losses.
How Coverage Discovery Works
Coverage discovery technology integrates seamlessly with existing revenue cycle management systems. Once a patient is discharged, the system continues to query extensive data sources regularly, cross-referencing patient information to identify any updates in insurance status. This dynamic approach ensures that if a patient’s insurance status changes, or if retroactive coverage becomes available, the provider can resubmit claims promptly.
Realizing Revenue Recovery
Many healthcare providers are already experiencing the benefits of post-discharge coverage discovery. One large health system in Georgia, for example, was able to recover $2.9 million of dollars in revenue by utilizing a coverage discovery technology solution. After adopting the technology, they were able to discover insurance coverage (commercial and government) for unpaid accounts of hospitals, clinics, physician groups, and more. By acting on this information, they successfully resubmitted claims and saw a significant boost in their bottom line. Read the case study.
In today’s healthcare environment, where margins are increasingly thin, recovering every possible dollar of revenue is crucial. Coverage discovery technology allows healthcare providers to recover lost revenue post-discharge by identifying insurance coverage that was missed by other vendors. By leveraging this advanced solution, hospitals can reduce write-offs, streamline their administrative processes, and ultimately improve their financial performance.
20/20 Revenue Maximization Partners
Are you ready to discover more revenue? Reach out to 20/20 Revenue Maximization Partners. We specialize in post-discharge insurance coverage discovery and utilize advanced technology to unlock the full potential of your revenue cycle. Contact Us to learn more or request a free consultation.
