maxRTE Success Stories
Premier Health UNCOVERS $2.9M IN THE FIRST THREE MONTHS OF LEVERAGING INSURANCE DISCOVERY FROM maxRTE
Project Background
Following the end of the public health emergency (PHE), Premier Health experienced an increase in self-pay patients and sought an insurance discovery solution that could identify the correct plan upfront to ensure timely reimbursement and reduce denials. With their extensive network of hospitals, medical organizations and physicians, Premier Health is one of the largest comprehensive health systems in Ohio.
Results
- Receives results that are 100% customized to Premier’s payer mix, reducing their need to manually weed out non-billable discoverables
- Able to run insurance discovery at multiple stages of the revenue cycle, including pre-service, day of service, and during look-back periods, ensuring comprehensive coverage verification
- 56,000 accounts processed in the first three months
- $2.9M in remits from insurance discovery in three months
- 50x return on their investment
maxRTE PROVIDES BETTER OUTCOMES FOR INSURANCE VERIFICATION PAINS AT INDEPENDENT, NONPROFIT, REGIONAL HEALTH CARE SYSTEM
Project Background
Frustrated with a decade-old cumbersome and costly system to verify patient insurance coverage and eligibility, an independent regional health care network serving the Minneapolis-St. Paul southwest-metro, was open to alternatives. Their objective was to simplify admissions procedures and offer pricing options to reduce costs, as well as to be supported with personal, responsive service. This health care network included advanced health care facilities, an acute care hospital and primary and specialty care clinics, as well as emergency services and specialty programs.
Results
- Simplified insurance verification processes, enabling pre-registration staff to take on significant new responsibilities with no increase in headcount
- Obtained requested changes and enhancements to the software usually within days
- Decreased coverage query fees by 50%, saving $60,000 per year while improving predictability of costs
- Enabled adoption of industry best practices in admitting and financial clearance
- Slashed coverage denials from 8% to 2%, consistent with nationwide best practicee
ACUTE CARE FACILITIES ARE UNCOVERING INSURANCE SOURCES FOR SELF-PAY PATIENTS
Project Background
The frenetic pace of emergency rooms in acute care facilities makes them especially vulnerable to missing insurance coverage during the registration/admission process. An established provider of self-pay conversion services uses affordable, efficient pre- and post-service processes that are helping hospitals, clinics, physician groups, and other healthcare providers strengthen their financial picture by uncovering commercial and government insurance coverage for self-pay patients.
Results
- Automated processes dramatically reduce costs of unearthing unknown insurance coverage for self-pay patients to maximize ROI for healthcare providers.
- Converted uncollected bills from self-pay patients and unknown secondary insurance from primary insurance holding patients to revenue.
- Two acute care facilities (800-bed and a 40-bed) improved conversion of self-pay patients by an average of 348% with $576,000 per month in additional insurance payments.
- Flat monthly fee arrangement saves 800-bed facility $2.7 million in contingency fees and more than $80,000 in per-transaction fees.
- Flat monthly fee arrangement saves 40-bed facility $70,000 in contingency fees and $10,000 in per-transaction fees.
