Advances in technology boost providers’ ability to screen the self-pay patient
Perspective | Brian Andrews
Senior Vice President & General Manager, Revenue Optimization Solutions, Change Healthcare
Andrews’ professional experience includes versatile leadership in IT product development, services operations, marketing, and product management. The last 12 years have been focused exclusively on healthcare revenue cycle IT.
It’s a dilemma that challenges hospitals, physician practices, labs, and durable medical-equipment companies (DMEs) every day: How do you determine if a patient presenting as self-pay or charity care has undisclosed insurance coverage, without compromising compliance requirements?
The liability of self-pay accounts is a growing problem, with providers incurring billions of dollars in losses each year. An American Hospital Association report shows hospitals provided $38.3 billion in uncompensated care (including bad debt and charity care) in 2016 alone.¹
Providers need an aggressive-yet-compliant method for identifying sources of reimbursement in a timely manner, before filing deadlines, and before the only option left for recouping payment is to engage collection agencies — a last-ditch strategy with traditionally low returns.
The Root of the Problem
Capturing complete patient information during the registration process is not fool-proof, and in fact, is fraught with pitfalls. Many providers’ processes do not capture all available data, or patients may inadvertently or willfully withhold information.
Additionally, human errors made in the collection of basic demographics (name, address, Social Security number, insurance, employment) can also mask a patient’s eligibility for insurance coverage or financial assistance. And even when this information is captured and accurate, there is no guarantee that all insurance sources have been identified.
Regardless of the reason, once patient accounts have been labeled uninsured, providers have traditionally had two options: conduct eligibility searches, or accept that a percentage of accounts will inevitably fall to collections, and ultimately, become bad debt.
Advanced analytics and rich data resources can help providers tap new sources of reimbursement while maintaining compliance.