When maxRTE consultant Brad Skelton presented the company’s Payment Discovery ROI projection for a three-hospital, 245-bed system in North Georgia, it appeared to be “pretty much a no-brainer.” He explains that the director of operations believed in the concept of reassessing patients who previously were identified as self-pay to determine insurance eligibility and coverage.
“The challenge was finding an attractively priced service that would deliver a healthy ROI,” says Skelton. “Most vendors operate either on a tiered-pricing basis, price-per-click scheme or contingency fee, all of which typically become too costly for a clinic, hospital or health system. Our flat monthly fee was the icing on the cake.”
The actual numbers are a testimony to the service’s ability to find previously unknown Medicare, Medicaid and commercial insurance and in doing so, eliminating costly self-pay situations, write-offs and unwarranted charity designations.
“And while the bottom-line benefits for hospitals speak for themselves,” says Skelton, “our clients see firsthand that Payment Discovery gives their patient relationships a huge boost. When the hospital finds coverage patients didn’t even know they had, you can imagine how grateful they are for the peace of mind you’ve given them.”
A snapshot of the hospital system’s results from July 2016 to July 2017 says it all. maxRTE Payment Discovery found insurance for 4,649 patients who had previously been deemed as self-pay. Reimbursement for these patients totaled $3,473,407.
And here’s what makes the hospital’s decision to use maxRTE Payment Discovery so brilliant. Another vendor’s fees would have totaled $451,543 for these patients, while maxRTE’s fees were $120,000—a savings of more than 60%. The $331,543 difference in vendor pricing is nearly 10% of total reimbursements.
What’s more, the registration staff agrees that the maxRTE real-time eligibility platform tops the system they have in place for up-front eligibilityfor dependability. Staff says the other platform regularly experiences payers down or site maintenance. In addition, maxRTE’s platform frequent payer function is a huge time saver. It allows staff to check self-pay patients simultaneously against their most frequent payers—at no additional charge. The other platform requires them to check each payer individually manually.
|Payment Discovery Performance Results for Fiscal Year 7/16-6/17|
|Other Vendor Rate||$451,542.93|
Can you afford to overlook Payment Discovery?
When your front office gets overwhelmed juggling patient registration along with the phone and scheduling appointments, the challenge of verifying insurance eligibility can understandably take a back seat to handling patients’ needs. There’s also the possibility that your computer system may be down or overloaded, prompting staff to sacrifice their search for insurance eligibility to make sure that patients are seen on time. Then there’s always a possibility that a patient has added retroactive coverage since first registering or being admitted.
If you can quickly and easily discover and verify missing insurance coverage for at least 10% of your patients, you can limit denials, early-out services costs, collection costs associated with self-pay receivables, get paid sooner, and reduce the amount of time any individual has to manually work an account.
Every dollar found is a dollar not spent on collections by your staff, expensive collection agencies, or bad debt write-offs. Capturing more revenue with minimal overhead is an advantage worth pursuing.