Protect Your Revenue: Leveraging Technology to Discover and Verify Insurance in Real-Time Prior to Care

Introduction to Revenue Protection Webinar

Hello, and thank you for joining us for today's webinar, "Protect Your Revenue: Leveraging Technology to Discover and Verify Insurance in Real Time Prior to Care," sponsored by FinThrive.

To get us started, I'd like to introduce our speakers for today, James Bush, solution strategy manager at FinThrive, and Cole Jackson, director of revenue cycle at McCurtain Memorial Hospital. James and Cole, I will hand it off to you.

Thank you so much, Lily. I really appreciate that. Very good afternoon, everyone. My name is James Bush, and I'd like to welcome you today's session on protecting our revenue by leveraging technology to discovery and verify insurance with real time insurance discovery at point of care, at precare. My apologies.

And I'm joined today, of course, by, the chief of revenue cycle, at McCurtain Memorial Hospital, mister Cole Jackson. Wanna say hello, Cole?

Hello, everyone. Appreciate you having me today, James.

Awesome. Thank you for being here today with us.

Overview of Revenue Challenges

In this session, we'll kind of examine how real time, technologies can reduce, of course, those front end denials and revenue loss. We'll explore methods to lower administrative costs and redirect resources towards patient care. We'll identify potential revenue leakage points, in our conversation today, and then we'll talk about some strategies to minimize those leakage points for faster payments.

Throughout our session today, of course, I think as, Lily mentioned earlier, feel free, of course, to to chime in if you do have questions or drop those in the chat, And we'll, of course, have a a q and a session towards the end of our conversation today.

Excellent.

So what I wanted to do first, with our conversation on, on technology, being on the front end and discovery at the front end is really take a look at first what the problem is and understanding, of course, the status quo, what most health care providers are really faced with operationally and financially when it comes to challenges in health care.

Obviously, of course, as you kinda look at this slide, I know some of those numbers and, some of the information there really speaks to a lot of us in the audience today, primarily maybe, data accuracy, which is a major issue for most, because that leads directly to claim denials.

Outdated, patient information, of course, is a big issue.

Of course, in that realm of insurance and billing, we know, of course, that that is a tremendous problem, actually grossing about two hundred and sixty two billion, annually for, providers across the United States. So, and then lastly, obviously, operational inefficiencies.

Tons of manual processes. I do get a chance to kind of, engage with, RCM leaders across the the the US, and everyone is kind of facing some of the same problems. They do have manual processes. There are paper based methods that are being used not only for, discovery and coverage, but also, like, admit notif notifying and, order management. All those things, of course, cost us billions annually. So we need to try to a way or find a way, I should say, to address some of these issues, as health care leaders, in order, of course, to improve, our our ANR days and, of course, reduce those denials in the back end. That's where all those numbers and facts and figures are coming off, from on the the right hand side there.

Key Areas of Concern in Revenue Cycle

Now, ultimately, what all of that really boils down to, is about four different areas. Specifically, when we're talking about the front end process and where, things are breaking down, if you will. Obviously, of course, manual processes.

Staffing issues is a grave concern, not just for, probably your organization, but I think if you did a head count, or a hand, count of hands, a show of hands, it's a issue across the the board when it comes to health care. Staffing is a major issue, specific, of course, on the front end, my patient access teams.

Changes in coverage. Right? We have now entered into, was it October fifteenth for, for, enrollment?

We're coming up on, of course, on a new year. So, as people change jobs, so does, of course, the, the coverage available for them. So and, of course, as I mentioned earlier, inaccurate data. All of those four those four points, I should say, are the primary focus of, kind of today's conversation on, the tech that can be applied to just the discovery process and how important the, the front end process is in totality.

Understanding Revenue Leakage Points

What I wanted to do was, first, give you an idea of where some of the leakage points really occur. And it was a very difficult time to kinda even, outline where, in the process these things happen.

But, because the conversation is focused on that the front end process today, that's where I wanna focus a lot of my attention.

And so in this diagram, I take the four areas there of concern, manual, processes, staffing, changes in coverage, and, obviously, in inaccurate data. All of those deal with, of course, the front end teams, my patient access teams.

A lot of things happen in that very first encounter with the patient at point of registration.

When the patient presents with, with no coverage in that instance or James is on vacation, in in your area, and I don't have my card handy. Obviously, we don't wanna stop the the flow of service for that particular individual. We wanna kinda keep the, the party going. Right? Well, in that instance, that then initiates our manual process of figuring out where in the world, does James have coverage? He says he thinks he has it somewhere in his in his pocket. He doesn't.

Or he gives you a, a name of a of of a third party, it doesn't exist, or, you you can't find it anywhere.

That process can take upwards to two days.

Right? Because your team is manually now going in and trying to find coverage for that individual. And, again, if I don't have it on, on hand, you just kinda gotta pushing it pushing it down the hill or or kicking that can, if you will, down the hill for, for discovery, which then pushes out the, another part of the process, the insurance discovery process out two to three days there. So that's a whole another team now working all those accounts of those self pays, all those James' floating out there, are now being pushed to a whole another team to kinda work that information.

And that can kinda carry on all the way up to timely filing.

So, it it becomes a problem because then well, who's gonna pay for this? Because, you know, once Jane Lee James leaves the facility, it's gonna be really difficult to get me back in there, to pay said bill. So we wanna make sure that we're capturing any information at the, the point of registration if I can, as soon as possible.

Importance of Front-End Processes

And when we kind of thought about what we're gonna talk about today, I wanted to make sure too that, we level set and, remember that everyone in the audience may not understand where we all play in the sandbox, in RCM.

And I think this is really, really important, especially for my leaders on the the call, because while you may understand where, you know, the importance of the, of the front end, and maybe you're on the back end. I'm not sure depending on where where you are in your, organization.

Sometimes, our individuals, our teams may not understand where we sit, within the, that space.

Really, case in point is I had some opportunities to kind of talk to, some of the back end. So I used to support all my back end, folks out there, my billing managers, business off business office managers. I'm one of your peeps too.

And it was very difficult when I would review the clean claims report, and some of those denials that they were receiving to have the conversations, of course, with the leaders on the front, and letting them know, hey. The these things that they're seeing here could be alleviated, if we were to, you know, correct those on the front end. So if you're looking at my little diagram here, this is my revenue cycle, if you will, or revenue, square, the a rectangle, here. But if you look at those three areas there, that represents, my front end teams, registration, insurance verification, and the whole check-in financial clearance process. I kinda, you know, some, summarized it in those three little squares there before it got to any of those other spaces. Yes.

The denials happen in all those other areas. You're absolutely right. You know? Because I I'm pretty sure that you're saying that from from the audience. Yes. They do happen in those other spaces. But it's important for us to know that sixty to sixty five percent of those claim denials are coming from the front end.

They're coming from the very front, of the or the the the call is coming from with inside the house. It it's coming from the the front end there. And if we are able to at least, prioritize some of the our our efforts in that space, we can definitely, come out and we can reduce a lot of those actual denials themselves. So I wanted to always make sure that we kind of level set and understand where we are in the revenue cycles process before we start talking about, the the discovery process and applying technology.

Clarifying Terminology in Revenue Cycle Management

Next, I always, you know, wanna level set with the the terminology that we're using in our conversation today.

You'll hear me quite frequently, mention insurance verification or insurance discovery.

By verification, I mean, our RTE processes that we have at our facilities, your eligibility and benefits, processes or whatever you, like to call those, in your space. So insurance verification is doing just that. It's verifying the coverage that has been presented to you.

Now, again, we know this can be a manual process for some. We'll talk about that in in in a moment. And then, we, of course, have a discovery process. Insurance discovery, of course, is when James presents without any coverage in hand or you find that there's a a lack of coverage for me, you can then perform a discovery for, for your your patient population.

So I always, again, wanna make sure that I I I get the terms out there so that we're all on the same page. So when you hear me mention, insurance verification, I'm more than likely talking about, your eligibility or RTE. So just feel free to replace my, my verbiage with what works best for your facility. And the same thing that goes for insurance discovery.

I might say ID or you might hear the, the, the initials ID used in here, the, or RTID, real time insurance discovery. It can be used, of course, in in the the same vein as, of course, insurance discovery. So I wanna make sure that we're clear on that.

The Role of Insurance Cards

So next, I I, I I I wanted to take base, or talk, about Home Plate. And Home Plate for us in in for in this space is the insurance card.

The the reason I want to, come here is because there was a really wonderful article presented by Naham, a few, probably, I think, a year or so. And it was called Why Listening to a Health Insurance Card Matters.

It matters because all of those facts and figures, it matters because of that two that two hundred and sixty two billion, dollar figure that I put out there. It matters because of that sixty to sixty five percent of denials are coming from the front end.

You will find, obviously, especially now in days because everything is digitized, a lot of your patients are presenting without that card in hand.

Right? I know you've already trained your teams up and your teams know, of course, to review, the card for the co pay and the for the deductible, etcetera, and for the policy number. But what happens when the patient doesn't have the card in hand? What are your policies when, the the it's not there?

Are you thinking about what preregistration looks like in getting your patients to maybe, send that card ahead of the actual appointment using technology to scan that card, into your system? And then they can, of course, verify or double check what's currently inside of your EMR, your host system. System.

Right? Doing just some of those simple things, going back to the basics, which, of course, is an insurance card and making sure that your team understands the importance of reviewing said insurance card is, going to help you avoid a lot of those billing nightmares.

Right?

So we we have to, of course, refocus and get back down to the source. So we can apply tech to this too. Just, just something simple as maybe an OCR technology can be applied to the, your the scanning of the insurance card, and and then that can just be used to double check information that's currently inside of your host system. But that's just a kind of a nugget there that I wanted to talk about.

Impact of Technology on Insurance Verification

What does the application of, insurance verification or RTE eligibility, have on your organization?

Well, once you take and apply maybe a, an automated process to this or technology, if you will, to your, insurance verification or your E and B process or your RTE process, you can find significant reductions, and not only in just the eligibility verification process, but the amount of time that your staff is doing, just the simple verification process.

You may think that you're alone out there with, doing this manually or having to go from, portal to portal, from screen to screen. I know many of my, my peers, out there, at the at the in the jungle, I say, are doing it manually. They're they're going to all their payers. They're typing in, of course, the information and then coming back, to verify that information. That is time consuming.

It's very, very time consuming.

The the goal should be, is to, align yourself with some technology that can, automatically scan that coverage that the patient presented to you.

Right? Once it scans that coverage, it not only sends you back a two seventy one response. Two seventy one responses are are wonderful. I know they, they have lots of information in them. But the the goal should be to to streamline your your team's workflow and expedite that particular process. The ways that that can be done is making sure that that technology can not only just provide you the two seventy one response, but you want the technology to also sort the benefits.

Because there's nothing worse than me sitting here in the ER reviewing a two seventy one and having to go down, scroll down, three to four pages before I can find the, the emergency room benefits. So you want that sorting. You want things like benefit tagging that can go in there and call out the deductible and the amount that's due, at point of service so that your team is not having to do that extra work. And while it seems kind of trivial that it's only a couple of seconds that they have to, to scroll, and it's only additional minute or two for them to go and review this information, with each one of those seconds in additional minutes, you've added on to the experience of the patient or you reduce the the, the patient's experience. You've added on to the amount of time that that patient has to sit there or that staff and brass to review that information. So you really wanna make sure that you're doing that. Additionally, by adding that technology, you remove human error.

You remove human error. So now if if I could have gone to that portal seventeen times and still didn't see it, but the tech the the tech is gonna get there faster. It's gonna report back in a in a, in an accurate manner. So we wanna make sure that we're kind of really looking at technology to to look at how we're doing, of course, our insurance verification process and our eligibility process, in totality.

Exploring the Discovery Process

And then that brings me to the next part. So remember I was talking about two different, two different angles, insurance verification and, of course, our discovery process.

It was great when James had a, a card, in hand and he's able to present it to you, or I knew, firsthand that I had Cigna or Aetna or or Medicaid or whatever services.

But what happens when I don't have my card in hand? I may self pay. I walk into the emergency room. Or I'm sitting out here, getting ready for my appointment. I registered, and I just didn't feel like putting in my card, with my, my schedule. Right? Well, you definitely need a solution, tech wise, to go out there, grab the data that's present, that has been given to us, that will go out there and then discover coverage for the, your patient population.

Right? What happens now is, there's these these are the self pays. I probably got an Excel spreadsheet, because, you know, we love our Excel spreadsheets. Not stepping on our toes. So I got my Excel spreadsheet of all the patients that are self pays. And now I'm one by one going to the various, portals to look for coverage for the patients for these upcoming days. It's time consuming, and people get distracted.

We just wanna be honest. Right? My phone rings. It's Cole. I'm like, what's up, Cole?

I'm now distracted. I'm I've I've I thought I was online, fifty seven on that Excel document, and now I come back and I'm on sixty three. I keep on moving. But those are three patients or our ten patients.

How many of I just jumped over that didn't get addressed, and I didn't get a chance to even get to any of those portals. And, again, I wanna repeat, it is time consuming, when that happens. What you wanna do is take a look at technology, and there's tech in, that's out there that can assist you in this manner. And it's definitely worth, the investment, in this space because what it end up this this tech does, it goes out.

It takes that demographic information.

It'll take a look at whatever payer groups that you have decided to take a look at and bring back. It'll do a a a very, very fast search and bring back coverage, that's comparable to, the, the patient population. It'll populate that information for your, for your team, completely saving you some time.

Additionally, many of these solutions out there, if it is confused, maybe there's two James Bushes or with the same demographic information.

Instead of kicking that out, it can then maybe work list that to the team members so that they can review that versus the hundred or two hundred patients that, they're with no coverage on there. Shorten that list down to two or three patients to review versus the the ten or twenty or a hundred that they would have to do before. So and as you can see here, of course, it reduces the the timely filing, the AR days, etcetera. The amount of time, twenty minutes plus, just having to look for coverage for a patient when, of course, I could be using that time to do patient collections or improve the patient experience in totality.

Okay?

Again, if there's, any questions, during the, the conversation, by all means, you can drop them in the chat, and I'll be happy, of course, to assist.

Okay?

Now what does this look like? What does this look like?

Benefits of Streamlining Administrative Processes

I've I've talked about this, and it seems like it's wonderful, but there's, great benefits, in, overall when you're thinking about this, streamlining administrative processes, and it will truly lower cost. And and what I mean by that is the a lot of our time, of course, is spent and devoted to that space. We could reallocate the those those resources to other spaces just by applying technology and automation to that particular space.

And once we do so, we can then identify those revenue leakage points that can technically plug a lot of those particular holes that we kind of, or that I outlined at the top of of the conversation.

All of those, those leakage points, could be filled in. And instead of maybe buckets pouring out, maybe it's a a drip or two.

And I I do have a kind of a a conversation or a slide that kinda talks about that.

You can continue that by developing additional strategies to minimize leakage points. What I probably would do in that instance is not only apply discovery there, but maybe even apply discovery from end to end.

Again, I have a slide that kinda talks about what that process looks like. But just a simple strategy is that of moving your insurance discovery from your back end to the front end will definitely streamline that, that flow. Then you can reallocate those individuals who were doing those to other things like authorizations.

Because we we all know that if I don't get the coverage right, well, there goes my, my prior auths. There goes my medical necessities. There goes my NOAs. Everything is reliant upon coverage, so we gotta get that right from the beginning.

Collaboration for Improved Revenue Cycle Management

And then, I have a a nugget here for collaboration.

This is a good time for you to reach across the aisles and talk to your your billing managers, the those who kind of lead up that team, because they have lots of insight back there of of what is who is leaking here. Because if you can get to them and they can tell you exactly, hey, James. I'm, you know, we're getting lots of, of denials because of this. A lot of my my billers are gonna have to touch claims on just simple demographic information.

That way, we can use the data that we collect from the back end, not just the denials reports, but, yeah, the clean claims reports that you're getting from your claims management systems. You can use that information to push that to the front to maybe improve processes, to maybe put in some QA reg tools, for the data that's coming through your your your HIM, your your host system. Get some QA reg tools in there to, to clean those up and do those clean registrations. And that information can improve the the processes on the on the back end. And, of course, us as RCM leaders can not only just talk to the the my patient access leader, but, I can verify that this is working for my patient access leader by the the data that I'm getting from, whoever's leading my billing team.

Okay?

Transforming Insurance Discovery Processes

Making, of course, an even and consistent workflow across the board.

What that looks like when we move a back end process to the front looks like this. It is in the point of registration, for that patient or the quick reg. We are doing the RTID process, the real time insurance discovery process. So no more does James just present without a card in hand or, any coverage, on file, and we just move forward. We we run that technology in the beginning to look for coverage for James.

Now in the event that coverage is not found, what I always suggest is continue that process. We call, here at Kentire, we call it AID, but that's active insurance discovery. That's moving up my, my discovery point from two to three days or four days or even after I've gone up to twenty four hours. Bringing back, of course, that coverage discovery to the front. Again, again, trying to capture as much information with a more robust search. And then, of course, in the back end, continuing whatever methods or measures you're currently doing, for your insurance discovery process.

Even, and a lot of organizations are doing, like, a safety net, for their insurance discovery. Using one vendor to go out there and look and then doing another one underneath there to just catch anything that might be falling.

In that instance, if you imagine those little bars or the squares at the bottom, all those are just buckets.

They're just buckets capturing whatever revenue that could possibly be leaking from your organization.

And when you do that, that changes this workflow, overall, as you could see. And if you look at my little bright green ThinThrive, circle there, moving that up to day zero. When we move that up to day zero, we've now automated entire processes. We've now done an active discovery within the first, twenty four hours at the first hour zero and, of course, the first twenty four hours. And then we've pushed up, any, maybe back end discovery processes by two to three days versus, of course, waiting to, to do our our our digging within there.

And that will help us out a lot when it comes to our, discovery process in totality.

Case Study: McKerton Memorial Hospital

So that's enough from me.

But, I didn't want you to just kind of hear it from me. I wanted you to hear it from, like, the the horse's mouth. I would love to reintroduce, the chief revenue officer, at McKerton Memorial Hospital. My good friend, Cole.

Appreciate it, James.

So just to give you guys a quick little background, on McKerton Memorial Hospital. So we're a small critical access hospital in Southeastern, Oklahoma.

There's about thirty thousand residents here in the, county.

With that, we have twenty five beds for the acute side, and, we average about twenty six thousand annual visits to the hospital and the clinics alike.

To give a little bit more background, just north of us, about fifteen minutes is a area named Broken Bow or Ho Chatown.

Here in the last four years, what we have experienced is kind of a tourist boom.

We went from having, I believe, that the average people that had came through the county wasn't around a hundred thousand a year that were outside visitors. Now we are averaging nearly three million visitors in a total year, from external places all over the world. It actually is in the top ten tourist destinations in the country right now. So we have with that comes a lot of challenges that present because our annual our traditional payer mix was somewhere in the range of seventy five to eighty percent Medicaid and Medicare.

But with that, our commercial mix has gone up. And with whenever we were first approached about real time insurance discovery because we had kinda voiced our piece to FinDRA because we've been partnered with them for the last three years, with our insurance eligibility and other, tools and resources that we've utilized, We went to them and we asked them, like, is there anything that we can do? They, made us aware of the real time insurance discovery app. And with that, it kinda came in a full storm because Oklahoma this year launched their Medicaid managed care. And, they went into a piece of all of the different commercial payers.

We mapped those, and it it gave us an opportunity to really kind of, streamline that process and do exactly what we've talked about, so far in the presentation of just minimizing the time and all of the pieces that we spent hours upon and multiple people trying to track that down on the back end. And it's really two of our main goals were to really cut down on denials in our AR days. So with that, just trying to paint a scenario for you. But, you know, McCarran Memorial, our biggest goal has always been to treat everyone with compassion and dedication.

We, you know, we wanna be good stewards to our community. So with that, we wanna reach that extending handout and not, have issues through the billing cycle and all of that, within external people who have approached us and come in. So or have visited our hospital. So, it's just part of, you know, continuing on our mission and goals. Back to just the point of the manual data processing and all of that, the pieces that we, you you know, experienced were we our days in AR had ran up to nearly eighty eight, and the national average, if you look at it, is around forty.

With this, we've been able to utilize this this resource. It's really coming in, crucial for, like I said, the Medicaid managed care with getting the appropriate, commercial vendors that, you know, mapped because a lot of those are now through those insurance cards. They don't have them or anything like that. They know that they have Medicaid, but they're not sure what company they're associated with or what have you. And with the real time insurance discovery app, it goes into each one of those without go having to go to the portal.

Personally, the clerk can immediately check their database and then bring that in, and we can it just cuts down on the time and processing.

So, you know, just this was a statement that they had asked that I give, and it really has I mean, I can't really reiterate it enough, but the guesswork was the main part of it all was really you felt like you were guessing, trying to figure out with the rollout of that program. And, with this, it has been monumental. So just a couple quick data points, but, the, you know, the accuracy rates of it all. The the reason that the accuracy rate does differ a little bit is back to James Point. We paired it with another piece called the patient identifier.

So, you can have two James Bushes or you can have two Cole Jacksons. And, you know, that accuracy rate that it kicks back, it will validate the based off of other demographic information that you've provided via the address or things like that. So we've paired that up, and I believe that that, accuracy rate has even risen since we've done that. Also, with the, the piece of the denial response time, that is one that we've been able to kind of duplicate almost reduce overall because of the piece with billing and the registration working together. It's you know, we've given our billing access to this, and they've been able to follow-up on that accordingly and really bring those times down as well.

Awesome. Awesome.

Thank you.

And so I and and and, again, if you do have any questions, please make sure that you kind of, put those in the chat, and we'll make sure that we address those.

And I'll I I'm gonna come to those two that I do see in, the chat in just a moment.

So a a lot of this is is backed by data. It's backed by data and actual research. So when we kind of came together and thank you so much for that, Cole.

We came together a few years ago to to really do a a strong look at where tech sits or specifically tech in the RCM space.

Assessing Technology in Revenue Cycle Management

And we developed something called an r RCM TAM framework.

This actual model kind of assesses mission critical and high value tech knowledge that are used across all stages of, of revenue cycle.

Ultimately, we do a deep dive or we request that you kind of do an analyze the the tech that you currently have in your space.

And then we then report back of, you know, hey. Where where does your organization actually sit, amongst your peers, and where are you getting the the most value, from your, your technology. I mean, we broke this down, into about five different stages depending on where your organization kind of sits, and what solutions, you are currently using in both front, mid, and back, of course, in analytics in order to kind of, you know, give you a good idea of where you kind of sit in that particular space.

A lot of, organizations are kind of falling in that stage two, area there, but, a lot of this conversation of, you know, moving that that back end, discovery process to the front came from, some of these tools like an RCM TAM, technology, tool itself.

Alright?

I do want to open up the the the floor for conversations and questions, that we may have so that we can try to answer some of those, kind of surrounding, what that technology looks like or what that would be, in the RCM space. So, of course, if there are any questions, please feel free to kind of, put those in the chat.

Alright.

Addressing Regulatory Concerns in Coverage Searches

I do see one, and it says, how do we get around the fishing regulations when randomly searching for coverage? Well, there's the the trick of that is that you are not randomly searching for, for coverage at all in this instance.

I have presented that I do, that I want services at, at Cole's facility.

Cole has all of my demographic information, when conducting this particular search. So we are not, technically fishing for, for anything. We are also targeting when you're doing, like, an RTID process. You are actually targeting, specific payer groups that you do feel that he would have or the patient would have coverage in, when doing that.

I know it's a fine loophole, but we are going through that loophole. We're we're threading it lightly to make sure that we improve our processes. So, but but that is what's happening. I'm not just randomly searching for, patient coverage.

We are using technology to to not only identify whether or not, whether or not the, the the coverage belongs to the individual. Like, for instance, if I'm I'm over sixty five, obviously, of course, I'm I'm gonna, shoot for, for my Medicare when I when I'm performing that. And, of course, I present it to myself to Cole, and team that I'm looking for, services at his facility. And so that's the loophole that we're using there.

Number two, I think there's a question in there about how do you handle HIPAA violations, wrong insurance added to, to the patient. So this is where we, we go with this.

In the the RTID process, yes. I'm I'm using my basic, demographic information, to, to leverage, that discovery process.

Within there, we use tons of tech behind the scenes. So while it just looks like I have just James Bush, I have James Bush with my date of birth, and there's tons of data kind of we all have a digital footprint. I don't I think that goes by, you know, no surprise that people have a massive digital footprint out there now.

We have multiple patent pin we have multiple patents here at Finthrive with our, our insurance discovery solution. On the back end, that's being used on the front end. So a lot of the information that you currently have, out there is used as a part of the, the algorithm to then search for, for coverage.

Number two, the human is still involved in this, this this whole ordeal. So when the coverage is brought back and if I'm not exactly sure that this is the right James Bush, instead of just immediately applying that to the patient's, account, that is when it's then work listed to your team. And so your team still gets the chance to put their eyes on and say, you know what?

This is this is off. This James is from California, and this James here is in Atlanta, Georgia. So, I'm not going to apply that. So you're you're not just, you know, accepting everything that comes from the insurance discovery process, as as gold. Your the human is still, involved there. What we've now has done is reduced the amount of time that they've spent, you know, doing that the the discovery part in, in total.

There's a question for you, Cole.

We currently use utilize Mediatek Expanse.

And for those who didn't see the question, the other question was, what ADT system do you use, and what systems do you partner with? And I'm sorry, Cole.

Alright. You're perfectly fine. The the other pieces that we partner with are just FinDry. We utilize a lot of their products for, you know, insurance eligibility, patient identification, address verification, real time insurance discovery as we're talking about, and then, medical necessity as well. And the a lot of those we're looking to and, you know, Finthrive does partner with them, and I believe that there's a lot of integration that goes into that. We're currently looking at optimizing that and getting it put into our EHR to not have to be going to the third party website and jumping back and forth.

Excellent.

Understanding Real Time Insurance Discovery (RTID)

The next question was, what is the name of the RTID software that, they are using? He's currently using, of course, a a FinThrive solution under, access coordinator. It is called, Real Time Insurance Discovery. It is called RTID.

It is not the only solution out there. There are other vendors, in this space as well. So I wanna make sure that I'm honest, with that. There's, there's other solutions out there, to take a look at, but you are looking for a solution that provides insurance discovery.

Good.

Any additional questions out there? Some more questions?

Let's see. Are you able to build custom edits around quality assurance?

So hey, Jeff. How are you doing? Yes. So the answer to that is yes. So, there's tons of QA reg tools, that that sit in that space.

When you're, looking for a QA reg tool, you do want one that not only maybe houses all of the the current, I would say edits or or or or rules, for just traditional denials, all of the demographic information, etcetera. But you also want want ones that are customizable. Right?

Because every facility, I've been to lots of them.

And you all do things so differently at your, your organizations. So, yes, the the there are solutions out there. Finthrive does has a have a solution that we can build a a QA reg. That also comes along with maybe some reporting, and balanced scorecards for the reg, registration teams, to see the quality of the registrations.

I always, again, strongly suggest taking those same reports, those QA reg reports that for your teams, if you do have a solution already in hand, and then taking that, that and looking at what, your your, clean claims report says, and and those should those two the errors that you get up front should be the errors that you're getting out on the on the back end and then, of course, rectifying that.

Monitoring Insurance Changes During Patient Stays

Let's see. Martha, without running insurance, again, on every admitted patient, is there a way to know if insurance changes during the their stay?

Yes. So, in in those instances and, and I wanna add a little, nugget to that. So, typically, you know, whenever you input something into your, your system, it triggers an h l seven.

If by chance, if you are then running it, maybe periodically, if you're if the stays, like, longer and you're doing it at thirty day and the thirty day period, just kind of flagging it again, it can, of course, do, an update. So if you have an insurance verifier solution that's just double checking the the coverage, then, it can then trigger the insurance discovery solution. So if, if Becky is in, the my facility and she's here for the the last thirty days, at day thirty, I did another verification of her coverage. If that verification comes back as faulty, maybe the coverage, elapse or is no no longer good, You could then trigger I RTID at that point to then find coverage, for her and then, of course, reapply that to the account.

Great questions.

Additional questions?

Enhancing Communication Through Insurance Verification

So, Jane, real quick. I just wanted to add, something real fast to the real time insurance discovery piece. Yes. There's a question that I had received actually in my inbox that had asked about, how does it improve the communications between the trans processing transparency and potential out of pocket cost and everything. An aspect that we actually do utilize it it for is whenever we first receive referrals from, say, outpatient services or anything from a specialist, we have our central wide scheduler here at the hospital.

She does basically the registration job just without the patient in front of them. She's doing, the all of the insurance verification, the, validation and everything. And she also back to your piece of the h l seven that it, auto triggers the real time insurance discovery. Whenever she goes to run that eligibility, it actually will show her our seven major payers that we have mapped.

It will show her if there's any insurance with those other others. It will then pull that. You can validate that that is the person that you're looking for, and then you can see the technicals behind their insurance plan. And then she once she reaches back out to them or this and this is just one process of it.

But once she reaches back out to them to confirm that that is their insurance plan, she sees that they have this information, she then can notify them by giving them a patient cost estimate through our another aspect that we utilize for pricing transparency.

So just another way that that's applicable in a situation.

Awesome.

Great. And thank you there, Cole, and thank you for whomever asked that question.

Let's see.

Integrating Insurance Verification with Workflows
What steps can health care organizations take to ensure that real time insurance verification systems are integrated seamlessly with existing billing and and clinical workflows? Okay.

I would probably take a look at, I would so always start with your whole system, first, because, obviously, you want that to be a source of truth, in many instances.

Many of your host systems have vendor, preferences or that vendors of, of, of preference.

And then use you know, take a look at, you know, who's leading in class. I definitely would do that, and then speak with those particular, entities. You'll see where, where there's embedding opportunities, with some of the, the EMR systems. Having worked in this space for quite some time, a lot of them don't allow you to embed, but that's okay.

If that is not the case, you wanna find, maybe a solution that, allows for multiple points of access versus just one.

What I do know about, of course, our our our wonderful front end registration teams and our patient access teams is that many of them spend time in prop they'll probably go to, like, ten different portals in one sitting. You you definitely wanna, if you have to then bring up another solution, you want that solution to encompass all ten different portals, if if it can. You want it to kind of, so that way that streamlines the the workflow.

Additionally, you wanna maybe find a vendor or find a a a vendor that can speak to multiple points within the RCM.

I'm just throwing back to that slide where I kinda had my, not circle, not cycle, but square, within itself. But you definitely wanna throw back to, an area or a space where a a vendor that can speak to multiple points in there, not just handle, of course, the patient access part, but maybe even draw reportings on, on the claims part or your CDM or your analytics. In that way, it you can have something that speaks across the board that really saves you time as a leader, and, allows you to have clear visibility across the entire revenue cycle versus having to to speak to, like, multiple different vendors. So take a look at your, your EMR or your whole system, and then, take a look at a vendor that can complement that whole system.

Thank you.

My pleasure.

Conclusion and Acknowledgments

In closing, we would like to give another thank you to our sponsor, Finthrive, and to our presenters today for sharing their time and expertise with us and to our attendees for your participation today. Have a great day.