Unlocking revenue potential through continuous insurance discovery
As financial challenges grow, healthcare providers are under increasing pressure to secure revenue. One key strategy in this effort is continuous insurance discovery, which has become essential in changing projected earnings into real returns while supporting patients on their financial journey.
“Continuous insurance discovery better positions healthcare organizations to realize more revenue and streamline operations from the moment a patient enters your facility until timely filing,” says April Wilson, vice president of product management for FinThrive. “With margins being as thin as they are for most providers, every dollar counts, and cash in hand is crucial.”
In the following conversation, Wilson explains how a comprehensive insurance discovery process can enhance the patient’s financial experience and help providers uncover more revenue opportunities. She also explores the benefits of proactive continuous coverage detection and key vendor considerations, such as seamless integration throughout the entire patient journey and flexible pricing, when investing in an insurance discovery solution.
Q: What is insurance discovery, and why is it important for providers to address throughout the revenue cycle?
Wilson: Insurance discovery is the process of helping providers find valid insurance coverage that might otherwise go undiscovered. It’s crucial to know as much as you can about the patient throughout the entire revenue cycle, from pre-service through billing. Insurance discovery helps fill in gaps in the patient’s background and involves them in financial decision-making, which enhances satisfaction. Having this information readily available optimizes the patient’s financial experience, especially in cases where the patient is incapacitated or there’s confusion about their policy. It also helps ensure accurate billing and prevents eligibility-related claims denials.
Although often used for self-pay patients who present without coverage, insurance discovery is also highly effective in managing coordination of benefits (COB) issues. For instance, if a patient arrives with secondary coverage, insurance discovery can identify the primary coverage. By adopting automated insurance discovery technologies, providers can significantly reduce revenue leakage by capturing every possible coverage option and billing appropriately.
Insurance discovery has significantly evolved from its traditional post-service focus to a more proactive pre-service approach. By shifting this process to the front end, healthcare providers can streamline operations and enhance efficiency for their staff. Addressing insurance details before a patient is discharged reduces the need for post-appointment clean-up, allowing staff to focus on more critical tasks. Moreover, with increasing expectations for staff to collect payments upfront, pre-service insurance discovery offers patients a clearer understanding of their financial responsibilities, presenting an accurate picture of what is covered by their insurance. This proactive strategy not only simplifies operations but also fosters transparency and trust with patients.
Q: What are the advantages of continuous insurance searches prior to the point of service over other solutions?
Wilson: Continuous searches allow providers to stay proactive in managing patients’ changing insurance situations so no potential coverage is missed. This approach helps protect patients financially and enables providers to recoup all possible revenue. Continuous search enables coverage to be checked right up until the timely filing deadline, so no dollars are left behind.
For instance, the provider might enroll a Medicaid-eligible patient during their hospital stay, but it could take months for the policy to be issued and applied to the account. During this period, continuous monthly searches are essential to identify and apply that coverage.
The financial impact of not utilizing continuous insurance discovery is significant. For one, it helps prevent denials due to COB issues. Also, insurers typically reimburse claims within three to ten business days, providing crucial cash flow. In contrast, billing patients directly often results in delayed or partial payments, taking up to 90 days to secure payment. Continuous search solutions also reduce administrative burdens, saving staff from the time-consuming task of manually finding active policies, which can delay payment processing.
Q: How does insurance discovery fit into a best-practice patient access strategy?
Wilson: A world-class patient access strategy involves gathering as much information as possible before the patient arrives. This process includes sending appointment reminders, providing estimates, assessing payment ability and conducting financial screenings. When collecting any payment up front, you want to ensure it’s a reasonable amount that the patient can afford. Confirming patients have valid, active insurance for their visit is a significant part of the process. This proactive approach guarantees patients receive comprehensive financial counseling. Thorough preparation improves patient satisfaction and simplifies front-office interactions, reducing unpaid bills. Ultimately, fully understanding the patient and engaging in thoughtful financial discussions fosters loyalty and strengthens the patient-provider relationship.
Q: If organizations are looking for an insurance discovery vendor, what are the three most important things to consider?
Wilson: First, accuracy is paramount. It’s essential to partner with a vendor who can identify patient coverage with precision, using robust systems and multiple layers of identity validation to avoid errors and ensure correct matches. A strong track record in delivering accurate, relevant coverage across all insurance types, including specialty areas like pharmacy or dental, is crucial. This level of accuracy ultimately saves time and confirms accurate billing on the first attempt.
Value is equally critical. You want a partner that understands your financial constraints and offers a solution that maximizes revenue recovery at a fair price. For example, features like continuous search, which is built into FinThrive’s platform at no extra charge, should be included as a one-time payment per record. If a person has applied for Medicaid, you shouldn’t be charged each time you check for that record to appear.
Finally, you want a partner focused on simplicity, flexibility and transparency. Embracing a subscription pricing model is essential in achieving this, as it allows you to leverage the full potential of your insurance discovery solution without budget constraints. Such a model helps you focus entirely on identifying comprehensive patient insurance coverage and uncovering revenue opportunities, maximizing your returns effortlessly. A great partner will offer advanced automation and intelligent systems to streamline processes while also providing options for manual reviews. The solution should be intuitive, allowing you to concentrate on the most profitable opportunities to recoup cash quickly. Transparency is key; the vendor should provide reports and access to advisors to help you understand the value you’re getting and to optimize your use of the product.
Additionally, Wilson notes that partnering with the right vendor can lead to a substantial ROI of 700% to 1,100% within the first year of implementing an insurance discovery solution. “A provider without an insurance discovery system, including manual processes, could be leaving six to eight digits of revenue on the table annually,” she says.
Interested in seeing how partnering with an insurance discovery vendor can help your organization uncover more hidden revenue? Download this buyer’s guide or visit FinThrive to learn more about the Best in KLAS solution for insurance discovery.
April Wilson is the Vice President of Product Management at FinThrive
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