Coverage Discovery

Why Coverage Discovery?

Much of the revenue lost to uncompensated care is simply due to patients being uninsured or underinsured. Another part is simply never billed due to carelessness or overwhelmed in-house medical billing staff. But it is estimated that up to 10% of the self-pay accounts that get written off are actually covered by billable insurance or a government health care program. This represents a significant amount of providers’ revenue that, up until now, has been difficult to recover.

Coverage Discovery Services Increase Revenue

The amount of revenue that has been lost due to uncompensated care is in the hundreds of billions. OneZero Coverage Discovery team tracks down coverage that patients may not even know they have and gets all possible reimbursements for our clients.

What’s Behind The Lost Revenue?

The source of all this potential increased revenue is coverage that patients may not even know they have. Young adults may not realize they are still covered under a parent’s plan. Another fairly common situation is a person not realizing they are covered under a plan arranged by their spouse

If they know about a secondary coverage, they often assume you receive the information when you look up their primary coverage. Medicaid and Medicare, with all their various parts, are challenging enough for professionals to deal with. It’s understandable that recipients, who are often either elderly or disabled, would not do the research it takes to sort it all out, and would assume your medical billing staff would automatically have access to the information needed to figure out what all their coverage is.

How Our Coverage Discovery Service Works

Clearly, it would be impossible to manually research all the possible payers for each individual patient. Coverage Discovery makes use of software tools designed specifically for the task. By automatically checking for coverage when a patient indicates they are self-pay, we are able to benefit both the patient and provider if any level of coverage is found. The tools include advanced search features, automatic claim scrubbing, a huge database, and algorithms designed to eliminate incorrect conclusions and false-positive results.
 

Benefits of Using Coverage Discovery

  • Identifies all levels of coverage to maximize reimbursement
  • Decreases days in AR
  • Decreases number of accounts sent to collections or written off
  • Reduces cost of collections for unpaid bills
  • Reduces overall bad debt
  • Increases patient satisfaction

Improve Front-End Eligibility and Benefit Verification

The Coverage Discovery process starts at the beginning of the medical revenue cycle with eligibility verification. Nearly a third of claim denials and rejections are due to errors right up front, before patients are even seen by the provider. Improving registration and verification processes provides the opportunity to greatly improve revenue. Some of the ways Coverage Discovery benefits the front-office process include:

  • Streamlines staff interaction with patients
  • Increases front-end collections
  • Establishes correct code matching
  • Provides guidance to staff
  • Reduces rejections and denials

Minimize Bad Debt and Write-Offs

There will always be patients who can’t afford the full cost of medical care, but by having correct information, providing patients the costs up front, and billing all responsible payers, more of your earned revenue can be collected. Now there is no reason to let services go unbilled because it isn’t clear who to bill.

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