How To Stop The Surge In Self-Pay Write-Offs By Finding Hidden Coverage You Can Bill Today

For years, healthcare providers have witnessed explosive growth in the number of patients who are self-paying or on high-deductible health plans (HDHP). Even for those who have commercial insurance, the patient share of healthcare financial responsibility is increasing. Since 2012, the average annual deductible for workers who are enrolled in healthcare insurance through their employer has blown up by 61%.¹

Self-pay and HDHP patients take longer to pay and pose a higher risk of write-off. This adds to the already significant financial strain on medical practice, emergency medicine and specialist providers. Therefore, it is in the providers’ best interest to search for healthcare insurance coverage as early in the patient encounter as possible to prevent the claim from becoming classified as self-pay in the first place.

One of the most effective solutions for combatting the lack of reliable patient demographic and insurance information is an automated revenue cycle management (RCM) optimization tool suite that can find, correct and verify patient and payer information. Providers who put AI-enhanced, real-time technology to work can improve their clean claims rate and pull payer dollars in more quickly. Automated RCM optimization tools can be integrated into existing workflows and systems as early as patient scheduling and registration, or later during billing and patient engagement. Essential tools include:

• Demographic verification — can help find, fix and verify core data (SSN, DOB, full name, etc.) on a majority of patient encounters.
• Insurance discovery — can identify active primary, secondary and tertiary coverage — including retroactive Medicaid.
• Insurance verification — confirms eligibility and benefits, and assesses coverage, co-pays, deductibles, secondary coverage and codes.
• Deductible monitoring — monitors when the patient deductible has been met and shifts primary financial responsibility to payers.

If it isn’t possible to add all these tools at once, the first investment should be in a robust insurance discovery tool that provides a confidence score. Best-in-class real-time insurance discovery technology delivers a clear return on investment (ROI) by finding more active, billable coverage — including coverage for previously presumed self-pay patients.

For example, the #1 2023 and 2024 Black Book-ranked ZOLL® AR Boost® Insurance Discovery tool can find active, billable coverage in real time for 40% or more of accounts. For specialty providers, such as radiology and laboratory, it can find even more. For example, the tool has found coverage for upwards of 65% of home health/hospice care providers’ patients with unknown coverage.

The ZOLL AR Boost Insurance Discovery tool solves providers’ most common challenges, such as:

• “Coverage not found” or “coverage inactive” errors
• Patients providing none or outdated insurance information
• Self-pay patients who actually have or are eligible for coverage
• Desire to reduce RCM team workload and time to collect
• Differentiating between managed care and advantage plans

To put the benefits of this automated insurance discovery technology into context, with an average commercial claim reimbursement rate of $250, a provider could generate an additional $50,000 in revenue per 1,000 self-pay claims (based on a conservative 20% additional commercial coverage found with a $250 per-claim reimbursement).

A proven, real-time RCM optimization solution suite like ZOLL AR Boost harnesses AI-enhanced, automated capabilities to help ensure data quality and reduce denials, increase revenue and accelerate time to cash. With no end in sight to the growing number of self-pay and HDHP patients, insurance discovery technology with proven, rapid ROI is definitely worth a closer look.

1 KFF Employer Health Benefit Survey Finds, https://www.kff.org/private-insurance/press-release/annual-family-premiums-for-employer-coverage-average-22463-this-year/, KFF health Affairs, accessed 2/23/23