When a 25-bed critical access hospital in central Georgia wanted to test maxRTE Insurance Discovery and Eligibility software, it was impressed with the tool’s ability to deliver secondary payers and additional revenue. But for Brad Skelton, it was a foregone conclusion.

 

Skelton, a maxRTE consultant, had become quite familiar with the software’s power when he was a regional manager for maxRTE, the company that developed it. While providing onsite services in Georgia and Alabama, he used maxRTE for scrubbing self-pay lists to find unknown insurance coverage and managing early-out collections.

 

Out of the 2,382 patients seen over 60 days (nearly 40 patients-per-day average), the 60-day test queried six payers for:

  • 494 self-pay patients
  • 1,492 patients with a post-primary reimbursement balance.

 

Out of the 56 self-pay patients that maxRTE discovered were eligible for billing, 30 had not exceeded billing time limits. For patients with a post-primary reimbursement balance, maxRTE identified 149 for Medicaid eligibility as a secondary payer—nearly 10% of the 1,462 patients in this group.

 

Commenting on this 60-day snapshot, Skelton explained that in an actual implementation, the results are typically even more remarkable. “The numbers are exceptionally convincing when the health care provider chooses a full complement of payers. When you consider that a flat monthly fee platform limits exposure to unplanned, excessive expense, maxRTE is a risk-free option with a guaranteed return. It’s a leap of logic for every facility I’ve ever worked with.”

 

So how do healthcare providers miss insurance eligibility for patients who get misidentified as self-pay? Registration in some cases fails to update insurance information at the time of registration, or patients that have applied for Medicaid coverage, are not yet eligible.

 

“The important point of this limited test,” says Skelton, “is that patients in this population who were identified as having no insurance coverage were eligible for some type of coverage, and maxRTE is the best option to help providers find it, accelerate revenue to the bottom, save providers collection costs, and enhance patient relationships. It’s one big win all the way around.”