Ideally, you would expect healthcare facilities to have organized data and complete information about patient insurance coverage. However, in reality, this is hardly the case. Hospitals are rarely this organized and often rely on bad debt, uncompensated care, and write-offs. However, with the help of the right insurance discovery provider, you can gain access to active coverage information.
Insurance Coverage Discovery Overview
Insurance discovery is a commonly used process in the healthcare industry to identify and verify a patient’s insurance coverage before providing them with medical services or insurance benefits. With insurance discovery, you can maximize claim reimbursement, so you don’t have to suffer uncompensated care or be forced to write off bad debts.
Depending on the size of the patient database, you could have hundreds or thousands of missing, inaccurate, or incomplete insurance information. This means your financial exposure is risky. If you can gain access to previously unknown information by uncovering insurance policies or coverage, you can dramatically lower this risk.
Benefits of Insurance Discovery for Healthcare Providers
Conducting an insurance discovery offers several benefits for healthcare providers. With more accurate and reliable information about patient insurance coverage, health providers can optimize their revenue cycle management. Accurate insurance information can help maximize cash flow optimization.
The impact of uncompensated care is massive. According to a study by Definitive Healthcare in which they surveyed more than 3800 U.S. hospitals, close to $40 million was lost in uncompensated care in 2018 in just the hospital included in the study. The smaller healthcare facilities were hit harder.
Facilities that have a process in place for insurance reimbursement revenue through healthcare insurance verification are far more likely to minimize their losses. The top insurance discovery providers use sophisticated tools to identify uncovered services, self-pay patients, commercial payers, potential billing issues, insurance denials, and other types of issues that can lead to revenue loss.
Healthcare providers also get the benefit of increased patient satisfaction. The providers gain access to what to expect in terms of costs, and as a result, they can make more informed decisions about the services they offer. This will help minimize situations where the patients are frustrated due to billing confusion or mismatched expectations about the care they receive.
Another benefit of getting a professional insurance discovery conducted is that it helps improve your operational efficiency by streamlining different healthcare administrative processes such as patient registration and claims management. While the insurance discovery service takes care of insurance eligibility verification, the healthcare provider can have all their focus on delivering the best possible care for their patients. Insurance discovery can also allow healthcare providers to document insurance information and authorization approvals to ensure they are compliant with all regulatory requirements.
Common Challenges in Insurance Discovery
One of the biggest challenges in insurance discovery is needing to handle the complexities of insurance coverage and the benefits in health systems, including collecting patient payments. You need a service provider who is well-versed in insurance policies and billing processes to handle insurance coverage discovery. Many insurance discovery services do not offer the in-depth service needed to identify self-pay patient accounts.
Ideally, you want a service provider that uses advanced technology solutions such as automated verification systems to maximize the efficiency and reliability of insurance verification.
Another challenge in insurance discovery is timely authorization. You don’t want to be in a situation where you are creating unnecessary delays for your patients. Insurance companies often have complex authorization requirements if your insurance discovery system is not designed to handle such complexities you are likely to face delays. In some cases, the documentation and paperwork burden, such as those related to medical records, can add more time to the process. This can lead to further delays in obtaining approvals.
Communication with the insurance companies for pre-certifications or timely authorizations is another challenge in insurance discovery. If you don't have a system or an established relationship with the payer, you could suffer issues in obtaining timely approvals. The compliance and regulatory requirements could also add further complexity to the issue.
Contact Pacific Liability Research to Conduct Insurance Discovery
If you want to get a professional insurance discovery solution, you can get in touch with us at Pacific Liability Research. Our team specializes in uncovering potential insurance coverage for individuals and secondary and tertiary healthcare facilities.
With our services, healthcare providers can minimize financial risk and maximize reimbursement. We use advanced research techniques and technology to identify insurance policies, verify existing coverage, and reveal hidden insurance coverage. If you like to learn more about our services or want to use one of our services, please contact us to get started.
