Streamlining and improving revenue is hyper-important for healthcare organizations right now. One challenge is finding the right patient payer information. Technology can help organizations identify more billable insurance coverage for self-pay patients, maximizing revenue, increasing efficiency and improving patient experience.
The following is a guest post from Inovalon.
Many healthcare providers find themselves wondering whether a revenue cycle management (RCM) partner would benefit their organizations. When providers can find the right partners – partners that add value to the organization’s industry expertise by delivering best-in-class technology – they can increase reimbursement dollars while decreasing denials.
Consistently high-performing financials take more than clean claims and quick workflows. Maximizing revenue cycles requires the seamless integration of a host of resources, processes, and innovative revenue cycle tools. To deliver the most value, RCM partners should provide integrated eligibility and identify additional billable insurance coverage as part of the process, providing better service to both providers and their patients.
Streamline the billing process
The right RCM partner will help providers optimize revenue by creating faster, easier processes to identify insurance coverage. As Medicare Beneficiary Identifiers (MBIs) only relate to Medicare coverage, providers need tools that will go beyond MBIs and caps from payer searches. Manual payer searches are time consuming and providers risk missing out on billable coverage. A lack of clean and standardized data from payers can make the process even more difficult.
That’s why the right RCM partners can help deliver all-payer search capabilities that create a complete view of applicable coverage for self-pay patients. Additionally, to increase efficiency and find payers faster, individual manual searches can be replaced with batch search tools. And to ensure their payer searches are delivering revenue results, providers can monitor the process using cost-to-collect ratios as a key performance indicator.
Find more billable coverage for self-pay accounts
With deductibles and patient co-pays higher than ever, clearing self-pay patients is more challenging and labor intensive than in the past. More importantly, providers risk lost revenue each time a patient leaves the office without paying. More than 40% of Americans have unpaid medical bills, totaling nearly $200 million, and half of U.S. adults report that they wouldn’t have the money to cover a $500 medical bill. These statistics underscore the importance of being able to find primary, secondary and tertiary coverage for customers quickly.
Unlimited payer searches that deliver fast results can help your customers avoid downstream denials and rejections by uncovering all coverage info from the start. Finding the appropriate payer at the start of a claim’s lifecycle can reduce reimbursement delays and decrease the number of days a bill spends in A/R.
Realize significant revenue gains
For providers to maximize and track revenue goals, they need access to capabilities such as ranking payer coverage, identifying managed care and advantage replacement plans, and outlining relevant list types. These tools allow providers to increase incoming revenue by reducing uncompensated care and underpayments.
Insurance Discovery from Inovalon finds up to double the number of payers compared to other services. At a conservative reimbursement rate of $150 per patient, Insurance Discovery could have potentially realized an additional $154.8 million in revenue, based on 2 million patient files that were analyzed in 2021 from 306 customer accounts.
Together, let’s discover better!
By partnering with Inovalon and providing access to Insurance Discovery, you can help your customers better serve their patients, while maximizing their revenue. Identifying all applicable coverage sooner increases patient satisfaction by taking away the burden of financial responsibility and placing it directly with payers. That reduces patient stress and leads to a more positive patient experience, all while increasing efficiency for providers.
For more information, visit Inovalon: https://www.inovalon.com/products/provider-cloud/strategic-partners/
