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 these findings, combined with a shifting payer mix, it’s estimated that 52% of patients will have government insurance by 2028. Therefore, it’s crucial for healthcare institutions to establish a thorough insurance discovery process to ensure they don’t leave money on the table. Although your institution won’t be able to uncover all payment opportunities, most of them can be uncovered through a rigorous insurance discovery process. Below are four tips to make sure your organization’s internal process is comprehensive and effective.

1. Retrace your steps
   Patient identification and demographic information can change over time. When this happens, new developments are not always reflected in the patient’s health plan, which makes verifying insurance eligibility a challenge. By rechecking insurance eligibility via internal processes and rebilling the claim, you can find missed coverage opportunities. Look for common errors that often lead to missed payment opportunities, such as name variations, common misspellings, middle or maiden names.
2. Do some digging
   Finding hidden coverage within Medicaid, Medicare and commercial health plans is complex and cumbersome. It’s a process that requires accurate, exception-based workflows to drive success. Assess your patient population and decide which health plan could be better represented in your recovery efforts.
3. Use propensity-to-pay data
   As patients take on more payment responsibility, preparing for potential payment obstacles is essential. Propensity-to-pay data can help you assess patients’ unique financial situations and segment accounts based on highest likelihood to pay, so you can focus on those first. For lower propensity-to-pay accounts, you can expedite the financial assistance assessment process—saving time and effort sending statements for accounts likely to qualify for aid. Being armed with propensity-to-pay information also allows for more productive third-party collection vendor arrangements.
4. Navigate the insurance discovery process independently, then bring in a third-party guide
   Hospitals can find nearly 90% of insurance coverage via their own internal systems, which is why it makes more sense to navigate the insurance discovery process independently. After evaluating your internal process, you can decide if it is feasible for your institution to bring in a third-party insurance discovery partner.

How an insurance discovery partner can improve your process

• An external insurance discovery partner can automate and expedite the process of sifting through patient information and looking for common errors.
• A partner with a holistic insurance discovery solution can leverage innovative data-matching technologies to uncover propensity-to-pay data, which allows your organization to make more productive third-party collection vendor arrangements.
• Hiring a best-in-class insurance discovery partner with advanced data and machine learning capabilities helps you capture hard-to-find coverage that may have otherwise gone to bad debt.

FinThrive is a healthcare revenue management software-as-a-service (SaaS) provider with the industry's most comprehensive end-to-end revenue management platform. Recently, we announced our new automation capabilities that work with your insurance discovery solution to examine 100% of found coverage. Our enhanced solution updates primary and secondary insurer information within your health system's EHR and automatically rebills the correct insurer for reimbursement when appropriate.

For more ways to maximize your insurance discovery findings, download our guide. Then learn more about FinThrive’s new intelligent insurance discovery solution.