Healthcare organizations are making great strides in recovering revenue despite the complexities of the healthcare reimbursement landscape. Using insurance discovery technology, sometimes referred to as coverage discovery, providers can quickly uncover and verify accurate insurance coverage, helping to ensure smoother claims processing and improved revenue recovery. This proactive approach not only reduces administrative burdens for providers, but also enhances the patient experience, creating a more seamless and efficient healthcare journey for all stakeholders.
This blog explores how insurance discovery works, why it’s beneficial for healthcare organizations and how this type of solution transforms how providers handle revenue cycle challenges.
What is Insurance Discovery?
Healthcare insurance discovery is the process of identifying additional insurance that the patient doesn’t claim. For example, if a patient doesn’t remember that they have multiple insurers – or in the case of an emergency visit – isn’t’ able to communicate their insurance – insurance discovery can verify eligibility and then find any additional eligible coverage. This helps providers reduce revenue leakage and maximize reimbursement opportunities.
Why is Insurance Discovery Important?
For healthcare organizations operating with narrow margins, claim denials due to missing coverage can result in significant revenue loss. Insurance discovery helps minimize risk by identifying all potential coverage resources and reducing reliance on manual error-prone processes. The result? Higher revenue recovery rates and a more efficient workflow.
How Does Insurance Discovery Work?
Insurance discovery workflows typically consist of the following steps:
1. Collecting Patient Information
Capture patient details at registration or check-in, such as demographics and primary insurance information.
2. Verification with Insurance Carriers
Confirm active coverage and eligibility for billed services directly with payers.
3. Cross-Checking Payer Databases
Search multiple proprietary and public insurance databases to uncover additional missed coverage opportunities.
4. Coordination of Benefits (COB)
For patients with multiple plans, ensure the correct payer order for claims processing to prevent delays or rejections.
The process can occur pre-service to mitigate errors upfront or post-service to salvage revenue from denied claims.
RELATED: Understanding the Claims Lifecycle: A Step-by-Step Guide
The Benefits of Automated Insurance Discovery
With high claim denial rates and a complex insurance landscape, automated insurance discovery is revolutionizing how providers approach revenue recovery. Here’s how automation transforms the process:
1. Recover More Revenue by Finding Missed Coverage
Problem
Patients don’t always provide thorough or accurate insurance information.
Solution
Automated solutions, like FinThrive’s Insurance Discover, dig deep to uncover hidden or overlooked coverage throughout the revenue cycle. Using patented data-matching technology, these systems search beyond basic demographic queries to locate sources of insurance, including gaps in secondary or tertiary coverage and can find coverage continuously throughout the revenue cycle.
Impact
One large Midwest health system using FinThrive experienced an average reimbursement increase of $50,000 per month.
2. Reduce Manual Workload
Problem
Administrative staff waste significant time manually verifying insurance information by calling payers and logging into portals, which is both tedious and error prone.
Solution
Automate repetitive tasks like payer verification and managing resubmissions. Leverage automation to continue to monitor insurance eligibility throughout the patient’s care timeline—even post-discharge.
Impact
Automation frees up valuable staff time, allowing them to focus on higher-value tasks while improving claim accuracy. McCurtain Memorial Hospital, a 25-bed critical access hospital in Oklahoma and FinThrive customer, saved more than 30 hours of weekly verification time with Real-Time Insurance Discover.
3. Prevent Insurance Eligibility Issues Before Submission
Problem
Many claims are denied because insurance eligibility details change after initial checks, leaving providers scrambling for fixes.
Solution
Real-time eligibility checks interrogate payer responses instantly, ensuring the latest benefits data is accounted for before a claim is submitted.
Impact
Faster back-end coverage discovery reduces errors, improving the speed of claims processing and your organization’s bottom line. Hear how Pennsylvania Mountains Healthcare Alliance (PMHA), a FinThrive customer, is seeing value from Insurance Discover.
Keep in mind that every insurance discovery solution isn't identical, and often, providers are missing out on significant revenue without having the proper coverage discovery system. Don't compromise; go for a tried and trusted solution that has proven its worth in the market.
FinThrive’s Insurance Discover has won Best in KLAS for Insurance Discovery three years running (2023-2025)! Our top-rated solution simplifies and provides real-time insurance discovery throughout the revenue cycle. It’s designed to help providers capture every dollar by using machine-learning tools and patented data-matching technology.
Here’s what sets FinThrive apart:
- End-to-End Coverage Discovery
Continuous monitoring ensures no missed coverage across the entire account lifecycle
- Unmatched Accuracy
Patented algorithms uncover coverage that other solutions miss—projecting up to 7% more recovered revenue
- Seamless Integration
Works within your existing workflows, including Epic and other EHR systems
- Proven Results
Over $7.8 billion in net revenue and cash recovered for customers
- Flexible Data Delivery
Customizable reports and tools to meet your organization’s unique requirements
With shrinking operating margins and increasing complexity in the healthcare market, insurance discovery is no longer optional. Automated solutions like FinThrive’s Insurance Discover provide the efficiency, accuracy and reliability providers need to thrive in today’s competitive landscape.
Don’t leave revenue on the table—invest in smarter real-time insurance discovery. Learn why FinThrive has been named Best in KLAS three years in a row and discover your organization’s revenue recovery potential.
