Understanding the Claims Lifecycle: A Step-by-Step Guide
Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As...
Amending your overall collections strategy—to focus more on total collections versus average cost to collect—can help ensure you get the best return on your investment.
According to a recent survey from AHIMA, the average net patient revenue for US hospitals is just under $200M – meaning a hospital stands to have on average $10M in denial losses annually. With volatile volumes, higher supply and labor costs, as well as shrinking margins, hospitals must rethink their revenue management strategy to remain financially viable. The fact is payers are not getting any easier on denials, and as such it is imperative to identify every last dollar of coverage to maximize cash flow in these challenging times.
Awarded 2024 & 2023 Best in KLAS for Insurance Discovery, FinThrive’s Insurance Discover™ solution is designed to deliver value and maximize reimbursements. Learn about how to capture hard-to-find coverage in our guide.
By the numbers
Being fixated on the price of a solution can affect your overall yield. Look at the following scenarios:
Hospital System A
Partnered with a vendor that offered an upfront, fixed rate for their insurance discovery solution and projected to uncover $1.4 million in additional revenue. $120,000 was invested in the solution; however, the solution ended up producing only $1.2 million in additional reimbursement, yielding the hospital $1.08 million in net revenue.
Hospital System B
Selected a vendor that only collected payment when reimbursement was received. This vendor projected they would uncover $1.5 million in additional revenue, but ended up delivering $1.74 million, for a total cost of $295,800. This ended up delivering $1.44 million in net revenue to the hospital.
While Hospital System A invested less money, it didn’t recoup nearly the same amount of revenue as Hospital System B. Here, the adage that you get what you pay for rings true.
Quick Tip
Perform a long-term cost analysis on total costs compared to total promised revenue recovered.
The lowest cost partner may yield fewer desirable results.
Time is money and quality matters
Just as the payment structure for insurance discovery solutions can differ, so can the quality and depth of the results you receive for reimbursable claims. Through your own internal processes, you’re likely able to find up to 99% of coverage. That remaining 1%—which includes the hardest-to-find coverage from self-pay, Medicaid secondary and potential coordination of benefits accounts—can be the difference between a year in the red or in the black.
By only looking at self-pay accounts, you may be leaving significant reimbursement opportunities on the table. FinThrive’s Revenue Recovery solutions dig deeper than other vendors to find more revenue.
When results aren’t properly vetted with advanced proprietary technology, you may be paying to view unactionable accounts, such as those already found using internal processes, not recoverable or which have already been paid. An accurate, organized list saves your team time and money. When it comes to finding coverage, choose quality in addition to quantity.
Awarded 2024 & 2023 Best in KLAS for Insurance Discovery
Learn more about FinThrive Insurance Discover.
