Navigating Year-End Updates: Adapting to Evolving Healthcare Machine-Readable File Regulations
The recent proposal introduced by the Centers for Medicare & Medicaid Services (CMS) on July 31, 2023, outlined significant changes to the Price...
In 2020, hospitals across the U.S. saw their median operating margin drop by 55.6%.1 The Coronavirus Aid, Relief, and Economic Security Act (CARES) helped offset escalating expenses, but the pandemic hasn’t been the only factor contributing to ongoing cash flow pressures. Various industry trends—a changing payer mix and rising uncompensated care—play a big role.
Healthcare organizations without a robust revenue recovery plan will face catastrophic financial challenges. That’s why it’s critical to maximize earning potential. Providers need to dig deeper to find missed insurance coverage and untapped dollars. The three reasons below offer insight on why it’s necessary and beneficial.
Not all coverage is easily attainable
Using existing internal systems and processes, most hospitals and health systems can find up to 99% of missed coverage. However, that remaining 1%—which would otherwise stay hidden and chalked up to bad debt—can be the difference between being in the red or black. Capturing this hard-to-find coverage requires the backing of a comprehensive insurance discovery solution. With robust data and analytics, an external partner can search beyond the surface for coverage, going deeper into complex payer scenarios.
Many vendors can’t find coverage either
Most missed coverage comes from self-pay accounts. And while recovering an additional .5% to boost your margin can be significant to your organization’s overall financial health, finding up to a full 1% is optimal. The problem is most external vendors don’t, and aren’t equipped to, look beyond self-pay.
FinThrive is different—we do.
Our comprehensive data and analytics capabilities search more complex cases, such as:
- Potential coordination of benefits opportunities on Medicaid accounts
- Medicaid as a secondary payer, driving increased Disproportionate Share Hospital (DSH) days and Dual-Eligible Bad Debt reimbursements
- Data needed to maximize reimbursements through the Medicare cost report
Finding this coverage improves your overall profitability
To remain competitive—and in some cases, keep doors open—it’s critical that hospitals and health systems ensure all earned revenue becomes paid revenue. Going that extra mile, by employing an insurance discovery solution that finds hard-to-find coverage can pay dividends in the long run.
FinThrive insurance discovery solutions can maximize revenue by digging deeper to identify hidden coverage—leading to a healthier bottom line.
Maximize your earning potential. Learn more about FinThrive solutions for Revenue Recovery.
