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Health Systems + Hospitals, Physician + Specialty Practices

How the right coverage detection solution can increase revenue + ease burden on your staff

How the right coverage detection solution can increase revenue + ease burden on your staff

As many Americans are painfully aware, medical debt can be financially catastrophic. Per a recent NBC News/Commonwealth Fund survey, one in three patients worries about affording healthcare, while one in five also reported problems paying or were unable to pay their medical bills the last two years.

Patients are generally taking on a larger proportion of their care costs, but they aren’t always up to speed on their own benefits and financial options. In many cases, patients have insurance coverage that could help alleviate their financial responsibility. In fact, up to 5 percent of self-pay accounts that are written off as bad debt actually have billable insurance coverage. The right coverage detection technology and strategy can identify this insurance, allowing providers to collect a greater portion of care costs from payers—rather than patients—and increase point-of-care patient collections.

Below are two steps providers can take to find more active coverage and collect fuller payment, more quickly, while nurturing positive patient engagement.

1. Take proactive steps to find hidden insurance coverage

Without the right technology, tracking down patients’ missing or unknown health insurance coverage is time-consuming and costly, and often involves multiple steps.

At the front end, patient-access staff try to verify coverage before scheduled appointments. If they can’t, either the billing staff will write off the account, AR staff will start collections or the account is outsourced to a third-party company for collection. Unfortunately, even after all this, 49% of patient responsibility is written off as bad debt, which negatively impacts cash flow, profit and patient relationships. A technology solution that identifies active, billable coverage that patients haven’t flagged can empower your team to collect more revenue and lower bad debt.

Coverage detection upsides and downsides

2. Create a holistic strategy for patient communication and collection

An automated coverage detection solution can make a big difference in how much providers get paid—and how quickly. After all, ineligible patient coverage is a leading cause of payer claim rejections and denials. But a coverage detection solution is really just one part of a larger strategy that can make life easier on your patients and your staff.

A proper holistic strategy considers the solution within your larger RCM framework as well as how it complements your patient engagement. It’s important to take a look at the larger picture and consider how your solution can improve or support other vital areas of your rev cycle, for example patient communications and estimates.

With an automated solution, you’re equipped to get critical financial information to patients as early as possible. A quick check using a coverage detection tool allows staff to find options the patient may not otherwise be aware of and even opens up an opportunity to collect from the patient at the point of service, since patient responsibility is likely to be significantly lower. Doing so ensures patients’ balance and financial responsibility information is presented in straightforward language. After all, it shouldn’t take a payor expert to understand a bill and its resulting responsibility.

Developing a holistic strategy gives patients convenience and flexibility in their payment options and streamlines the collection process, reducing costs, saving your staff time and increasing patient satisfaction and loyalty. And ultimately it’s those net benefits that will have the biggest impact on your bottom line.

Seeing COVID patients and billing to HRSA?
You’re required to attest you searched for coverage for the patient. A coverage detection technology solution is a much faster and more efficient way to do that than manually looking up coverage or calling payers.

The wrap up

By leveraging simple information, such as patient name and date of birth, Waystar’s Coverage Detection solution can identify not only primary coverage but also help determine coordination of benefits when a patient has multiple health plans. That ultimately leads to:

  • A reduction in collection costs through automation
  • Increased patient satisfaction
  • More billable opportunities pinpointed by reporting and dashboards
  • An immediate revenue boost, with the potential to confirm 2.8x more coverage
  • Upwards of 40% discoverable billable insurance
  • Optimized patient collection workflows with automated batch and single patient inquiries

If you’d like to explore how Waystar can automate your insurance detection processes, find more coverage for patients and calculate your organization’s potential savings and annual recoupment, learn more here.

Find this post helpful? Check out why basic eligibility checks might be costing you.

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