How to Compare Insurance Discovery Solutions
Brad Skelton, HFMI Regional Manager
Rising deductibles and a growing number of self-pay patients have catapulted collections to a critical level for hospitals, physician clinics, and other medical providers. They are looking for ways to limit collection costs associated with self-pay receivables, get paid sooner, and reduce the amount of time any individual has to manually work an account. Patients also win when providers utilize Insurance Discovery technology, which helps find insurance not known during registration, or retro-approved post-service.
Software vendors are not created equal. Neither are their products. To help you unearth the most effective, easiest to use, lowest-cost insurance discovery solution, here are five key areas to evaluate choosing insurance discovery solutions.
What is the vendor’s revenue cycle management experience working with hospitals and clinics?
Companies that have worked with hospitals and clinics understand the revenue cycle process from admission/registration desks to back office systems. They know how to make insurance discovery workflow most effective for your staff.
- Do they have experience with self-pay/early-out conversion?
- How long has their software been around?
- Do they have a comprehensive list of payers?
- Can they process all self-pay primary and secondary accounts?
- Do they limit transactions or the scope of what they will process?
Does the fee schedule meet budget requirements?
- For budgeting reliability, is there a flat monthly subscription model that includes unlimited eligibility transactions, no payer caps, and all payers (commercial and government?
- Evaluate the impact of vendors’ pricing models (flat monthly subscription, contingency fee, and price-per-transaction arrangements) on your self-pay patient population.
How difficult and/or expensive is it to implement the solution?
New software can mean new headaches and a difficult, time-consuming implementation. So it’s Important for a solution to integrate easily with nearly every practice and patient management system regardless of the organization’s size. This includes systems like Cerner, Epic and GE Healthcare-Centricity, CPSI, Meditech, Siemens, and HMS.
- Does implementation take hours, days, weeks, or months? Does it require any “rip and replace” in your current RCM system?
- What options are there for integrating the solution with EHRs?
- Are there options for classifying patients and receiving insurance inquiry responses by program code, insurance type, and patient classification?
- Are there options for securely uploading batch files—directly into the vendor’s portal, submitted to a SFTP, or submitted directly from an EHR?
- Are there options for receiving coverage results from an unlimited number of payers—directly from the vendor’s portal, EHR integration, or a securely exchanged file?
- How easy is it for staff to learn how to use the solution? Does the solution disrupt your current revenue cycle work-flow?
What results can you expect the solution to generate?
- What percent of patients on average does the software locate unknown insurance coverage for?
- How do results for a larger facility compareto a smaller facility? When comparing ROI for both larger and smaller facilities, don’t forget to include contingency and per-transaction fees.
- What does the vendor attribute their software’s success to? Is their secret sauce steeped in an algorithm technology, direct payer connections, knowledge of payer timely filing and retro-approval periods? What does the product road map look like? How often do they plan a software update?
Is a free trial available?
Any vendor with a product proven to be worth its salt would encourage a free test file to convince interested parties about the software’s ability to do the job.