Premier Health Uncovers $2.9M in Revenue with maxRTE’s Insurance Discovery
- Insurance Discovery
- Revenue Cycle Management
Revenue cycle management in healthcare can be complex and time-consuming, especially when dealing with insurance verifications and denials. For large hospital systems, this challenge becomes even more daunting, with the need to process large volumes of claims quickly and accurately. In this case study, we explore how Premier Health partnered with maxRTE to enhance their revenue cycle by uncovering $2.9M in just three months with insurance discovery.
The Challenge: Increasing Self-Pay Patients and Rising Denials
After the public health emergency (PHE) ended, Premier Health faced an increase in self-pay patients. The need to identify the correct insurance plans upfront became critical to ensuring timely reimbursement and minimizing denials. Premier Health needed a solution that could efficiently process and verify insurance information at multiple stages of the revenue cycle, especially in light of the changing healthcare landscape.
The Solution: maxRTE’s Insurance Discovery
Premier Health turned to maxRTE for a comprehensive Insurance Discovery solution. The solution was integrated into their existing Epic workqueues through SFTP, with real-time API integration in progress. This allowed Premier Health to run insurance discovery at multiple stages of the revenue cycle, including:
- Pre-service: Verifying coverage before services are rendered.
- Day of service: Ensuring correct insurance details are obtained on the day of the patient visit.
- Look-back periods: Verifying coverage for past services to prevent any overlooked claims.
The integration was customized to Premier’s payer mix, reducing the manual effort needed to sift through non-billable discoverables and ensuring the most relevant results were delivered.
The Results: Significant Revenue and a Strong ROI
In just the first three months of implementing the maxRTE Insurance Discovery solution, Premier Health achieved impressive results:
- 56,000 accounts processed within the first three months
- $2.9 million in remits from insurance discoveries
- 50x return on investment
The solution enabled Premier Health to streamline their insurance discovery process, reduce denials, and uncover significant revenue that would have otherwise gone unnoticed.
Key Benefits of Insurance Discovery for Hospitals
The success of Premier Health’s partnership with maxRTE highlights several key benefits of using Insurance Discovery solutions for hospitals:
- Increased efficiency: Automates the process of insurance verification at multiple stages, reducing manual workloads.
- Improved cash flow: Accelerates payments by identifying correct insurance details upfront.
- Fewer denials: Helps reduce the occurrence of claim denials by ensuring accurate coverage information is available early in the process.
- Customizable integration: Works seamlessly with existing hospital systems like Epic, allowing for smoother workflows.
Unlock Hidden Revenue with Insurance Discovery
Premier Health’s experience demonstrates the power of an efficient Insurance Discovery solution. By integrating maxRTE into their revenue cycle processes, Premier Health was able to uncover $2.9 million in just three months, significantly improving cash flow and reducing denials. For hospitals and healthcare organizations looking to optimize their revenue cycle, maxRTE’s Insurance Discovery solution offers a scalable and reliable way to maximize reimbursements at every stage of the process.
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