In today’s dynamic healthcare landscape, efficient revenue cycle management is essential for maintaining financial stability and ensuring quality patient care. In fact, it’s what sustains small practices and how large health systems preserve healthy profit margins. Insurance Discovery plays a critical role in this process by uncovering hidden coverage and capturing additional revenue. Unfortunately, it is often relegated to the backend, after patient care, which reduces efficiency, increases accounts receivable (A/R) and administrative costs, and strains patient-provider relationships.
Implementing AI-driven Insurance Discovery workflows pre-registration can transform the revenue cycle, delivering an impressive return on investment (ROI) of 50x+. Here’s how.
The Problem with Only Using Insurance Discovery on The Backend
Typically, insurance coverage is verified post-service, meaning providers search for coverage after the patient has already received care. This retroactive approach involves correcting or finding information after the fact, which can be time-consuming and prone to errors. Resolving these issues often requires extensive follow-up with patients and payers, leading to delays, increased workload for administrative staff, and a negative patient experience.
Providers only using Insurance Discovery on the backend are more likely to experience financial impacts from eligibility-related denials, including:
- Increased administrative costs due to the need for rework and resubmission of claims
- Delayed revenue collection, which affects cash flow
- Potential loss of revenue if claims are denied due to lack of prior authorization
The Role of AI in Pre-Registration Insurance Discovery Workflows
AI-driven workflows on the front-end streamline the Insurance Discovery process before the patient enters the door or at the point of service – helping staff find coverage early and confirm the information that they have on file efficiently. Here’s how AI transforms this critical aspect of the revenue cycle:
Pre-Service Verification
Verifying a patient’s insurance status, coverage, and benefits before they receive care helps avoid denials and payment delays. It can also empower patients to understand exactly what insurance will cover for their visit and what their financial responsibility will be. As self-pay patients schedule appointments, providers can also trigger Insurance Discovery in batches. Staff can then confirm the patient’s information upon arrival to ensure claim accuracy. AI algorithms can detect and flag discrepancies in real-time, alerting staff to potential issues in the data entered to avoid costly denials due to the wrong demographics or billing the wrong plan.
At the Point of Service
Leverage real-time Insurance Discovery via API integration with your EHR to locate patient active insurance at the point of service. This vastly improves the experience for patients who forgot their Card ID or who are unsure about their insurance coverage.
Ongoing Monitoring and Follow-Up
Insurance Discovery for self-pay accounts can be set up at regular intervals, such as at Day 1 daily post service or weekly to scrub for missed coverage (i.e., retroactively-approved Medicaid).
Financial Benefits: Achieving a 50x ROI
Implementing AI-driven Insurance Discovery workflows at the front end of the revenue cycle offers significant financial benefits that can lead to an impressive ROI of 50x+ the initial investment. Here’s how:
Faster Revenue Cycle
AI-driven workflows accelerate the revenue cycle by 15% to 20% by enabling providers to bill a claim earlier. This means that providers get paid earlier, improving the organization’s cash flow and financial stability
Reduced Administrative Costs
Implementing front-end Insurance Discovery can cut administrative costs by 20% to 30%. By verifying insurance information at the start, fewer follow-ups are required, and patients are easier to track – reducing workload. This proactive approach also minimizes incorrect statements and unnecessary follow-ups, boosting patient satisfaction. Additionally, EHR integration ensures that Discovery can all be managed in one place, so providers don’t need to navigate between screens.
Reduced Fees
Stop paying costly contingency fees that incentivize using Insurance Discovery on the back-end of the revenue cycle. Switch to a flat fee solution that allows the flexibility for using AI-driven technology in the front-end.
Reduced Denials through Timely Prior Authorizations
Upfront insurance discovery allows providers to secure authorizations sooner, facilitating a smoother claims process and patient experience. It also helps avoid common registration errors, like incorrect card IDs and demographic information, which 40% of providers list as a leading cause of denied claims. This method improves cash flow by preventing denials and alleviates the administrative burden of reworking and resubmitting claims.
Increased Revenue Capture
Implementing Insurance Discovery pre-registration can help providers identify coverage options for up to 25% of self-pay patients, flagging that coverage early and ensuring that they are able to capture the maximum possible revenue.
Real-World Success Stories with maxRTE
maxRTE’s industry-leading Insurance Discovery technology should be used pre-registration, finding billable coverage for self-pay accounts within seconds. This allows providers to access payers in a single click and learn about health insurance benefits that self-pay patients may not know they were entitled to. Numerous healthcare organizations have already reaped the benefits of our pre-registration and POS discovery workflows. For example:
- A large hospital system in Mississippi reports ~$3M of dollars in savings and an 80x+ ROI monthly by using maxRTE’s Insurance Discovery technology pre-registration
- A small regional hospital in South Carolina has seen similarly impressive results, yielding ~500K to $1M in savings and a 20x-50x ROI monthly from implementing the same technology pre-registration
Conclusion
The results speak for themselves: with remarkable ROIs of 50x+ and success stories from leading healthcare organizations, AI-driven pre-registration Insurance Discovery is a proven solution for accelerating your revenue cycle. Don’t miss out on this opportunity to achieve significant cost savings, capture additional revenue, and reduce denials. Discover the potential of maxRTE’s technology and see how you can join the ranks of leading revenue cycle organizations.