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Coverage Discovery

The Solution to Uncompensated Care & Unreported Coverage Challenges

Posted on Tuesday, March 21, 2023


Challenge: Uncompensated Care


According to the American Hospital Association, hospitals have provided almost $745 billion in uncompensated care to patients since 2000.


The AHA defines uncompensated care as “care provided for which no payment was received from the patient or insurer” or “the sum of a hospital's bad debt and the financial assistance it provides.” It does not include other unfunded care, such as underpayment from Medicare and Medicaid, that further impairs a hospital’s financial health.

Challenge: Unreported Coverage


Patients can fail to accurately present their health coverage or other personal information to their providers. They may have unknown or forgotten health coverage. They may move, change employers, have overlapping, secondary, and tertiary coverage, or switch insurance carriers, among other possible explanations.


When a provider is unaware of existing insurance coverage, they may pursue the patient for the cost of care rather than the insurer. Valuable time is lost which can impact timely claim filing with the existing but unknown payer. It is essential to pursue the proper payer as early as possible in the revenue cycle to prevent claim denials, reimbursement delays, and wasted time and resources.

The Solution: Coverage Discovery


With a large self-pay population, as well as more “underinsured” patients whose insurance coverage can leave them with high out-of-pocket expenses that they cannot afford to pay, hospitals need a comprehensive solution for addressing uncompensated care and unreported coverage challenges.


A coverage discovery solution is the answer. This technology enables hospitals to automatically find any existing coverage so they can appropriately direct collection efforts and maximize reimbursement.

EligibilityOne’s Coverage Discovery Solution


EligibilityOne offers an all-in-one solution that truly sets a new standard for coverage discovery:

  • Our solution goes way beyond simply generating a list of possible (active or inactive) coverages; it verifies that any coverage identified is actually in force and billable, then posts it directly to your system through an HL7 interface within 72 hours.

  • If our solution determines that a patient does not have coverage, we then screen them to see if they are eligible for health coverage. If they are, we help them with the application and enrollment process to obtain it so that their current and future visits may be covered.

  • Our onsite team strives to screen 90% of your self-pay patients before they are discharged.

  • We screen patients to find health coverage or program eligibility in real time – this helps to ensure you don’t miss claim filing deadlines or waste resources pursuing the wrong party for payment.

  • We scrub all accounts against major clearinghouses, state programs, and our own proprietary database. We search and update all programs available, including at the county, state, and federal level.

  • Our state-of-the-art technology is powered by HealthWare Systems, a leading provider of fully integrated, customizable workflow solutions and revenue cycle and patient management software. HealthWare Systems specializes in applying robotic process automation (RPA) to healthcare processes and utilizes RPA for its insurance verification and coverage discovery solutions.

  • Our comprehensive screening tool, AdvocatorAI, not only finds health coverage and program eligibility but is also designed to increase patient engagement and support patient advocacy through financial counseling and assistance.

  • We are here to serve you and your patients. Our services make enrollment much easier and quicker for patients while vastly improving the patient experience by helping you avoid the need to repeatedly ask them for payment.

  • With contingent-fee pricing, there is no risk to our clients; you don’t pay us until we’ve helped you collect your valuable reimbursement.

Contact us today to learn more about how our coverage discovery solution can help you find and verify unreported coverage while reducing uncompensated care for your facility.

 

By Stephanie Salmich

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