Brad Skelton, Vice President of Business Development
We’re putting insurance discovery software under the microscope to help you get the full picture, from every angle, about this topic. Since we’ve been helping health care organizations with their financial challenges for many years, we have a handle on the most common questions about insurance discovery. We’re answering some of them below, but feel free to send a question you might have about Insurance Discovery here, and we’ll be happy to answer it in one of our upcoming posts.
To kick the series off, let’s define insurance discovery as the search to locate previously unknown commercial, government, or exchange plan coverage missed during registration or retro approved post-service. Now let’s get to the root of the matter.
Why should healthcare providers care about insurance discovery?
Healthcare is a service business. And like all businesses—even not-for-profits—to stay viable and fiscally healthy, revenue must exceed expenses. If we think about both sides of this equation, we can say that the past 18 months has been like none other.
On the revenue side, COVID has been a huge roadblock as access to healthcare initially waned while providers instituted safety protocols and states mandated holds on elective procedures. In addition, fearful patients skipped wellness visits and screenings. At the same time, the increase in uninsured patients continued, driving an unprecedented growth in uncompensated care.
These two converging circumstances—deficits in both earned revenue and a deluge of uncompensated care—combined to create a hyper-focus on expense control. Healthcare organizations have become more cost conscious, with management considering ways to cut potential fat, including:
- They’re revisiting vendor costs to determine where they can renegotiate contract terms.
- They’re assessing workflow to determine how to streamline internal processes for greater efficiency and reduction in overhead.
How does insurance discovery help boost revenue and trim costs?
On the revenue side, it’s indispensable for uncovering previously unknown commercial, government, and exchange plan coverage. Including primary, secondary, and tertiary coverage. In addition to commercial insurance, perhaps they are eligible for Medicare or Medicaid, or are covered under COBRA. Maybe the front desk forgot to ask insured patients to update their current health insurance coverage, and it changed. There are so many reasons to adopt insurance discovery, and they all point to the need for insurance discovery to increase revenue and decrease uncompensated care.
Regarding expense reduction, providers are looking for every penny in light of increased supply and labor costs due to a pool that continues to shrink. When it comes to staff, time is money. Software that easily locates previously unknown coverage in self-pay primary and secondary accounts can add up to significant time savings and exceptional ROI.
How can we identify an insurance discovery solution that yields best ROI?
That is literally the million-dollar question. The first place to look is at software provider fee structures, which vary greatly. Is there a limit on transactions? Are there fees for duplicating inquiries per patient visit/treatment that constrain searches? Are there contingency fees applied to remits received on insurance discoveries found? Or are transactions unlimited for a flat monthly fee that’s budget friendly and could result in savings up to 70% depending on patient volume?