Reduce Denials with These Four Tips to Uncover Hidden Coverage
A recent report by The Kaiser Family Foundation showed that claim denials are on the rise, with some plans reaching up to 80% in denials. Based on...
Uncompensated care is a universal pain point for healthcare organizations—rising by $1.1 billion in 2020 to $42.7 billion.1 And while it may not be possible to eliminate it, there are initiatives you can put in place today to lessen its impact.
Emerging revenue management platforms are creating new opportunities to improve end-to-end process analytics, adopt advanced automation and ultimately find and fix revenue leaks.
Today, patients shoulder most healthcare costs. That means they expect the buying experience to be as seamless as it is in other industries. But it’s not. Given the shift in payer mix, it’s critical that healthcare organizations ensure price transparency, flexibility in payment and an improved patient financial experience.
When creating a go-forward revenue management strategy, consider the following four tips:
- Be up front with pricing and payment options
Your patients expect to know how much their healthcare is going to cost before they seek care. Make sure transparent pricing is easily accessible, in a format patients will understand. An online tool that provides an accurate estimate prior to service enables transparent, engaged financial conversations between all stakeholders. There are solutions available to help simplify this process—and it’s worth the investment, considering 65% of patients are more willing to make at least a partial payment when given an estimate prior to service.
- Establish funding mechanisms in advance of providing care
Establishing funding mechanisms in advance of care helps prevent bad debt and promotes a positive patient financial experience.
Determine the patient’s financial situation and ensure those who need assistance get it. Make sure those who pay can do so in the most flexible way, tailored to their unique financial position.
Put propensity-to-pay analytics to work. This helps segment patients into the most appropriate payment classes: who has the means to pay, who’s most likely to pay, and who qualifies for charity care and financial aid. This provides your team with the data needed to prioritize and more efficiently work accounts.
- Look for coverage opportunities
A patient’s eligibility for insurance coverage may change over time for many reasons, including data entry errors, plan changes and undisclosed coverage. Whenever possible, screen patients for insurance eligibility information before care is received, as this helps consolidate the claim cycle and drive yield.
Many hospitals discover self-pay patients with insurance coverage as late as 120 days after the patient’s discharge. Before making a bad debt placement, conduct a final commercial or public payer insurance coverage sweep to convert self-pay status to payer coverage.
- Make payment easy for patients
Healthcare bills can be confusing—often arriving separately from the physician and facility. When costs are unclear, patients are less likely to make timely payments. Mitigate this by offering patients a payment platform that makes it easy to:
- Understand when and to whom bills have been sent
- Request itemized statements
- Make payments from various payment sources
- Communicate digitally with hospital billing staff
Organizations that implement online bill payment, communication and financial assistance application programs typically benefit from higher patient experience scores, improved cash recovery and less bad debt.
Learn more about end-to-end revenue management.
Sources:
Fact Sheet: Uncompensated Hospital Care Cost | AHA
