Coverage Discovery Services Increase Revenue

The amount of revenue that has been lost due to uncompensated care is in the hundreds of billions. Medcare MSO’s 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 Highview Billing MSO’s 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 the number of accounts sent to collections or written off
  • Reduces cost of collections for unpaid bills
  • Reduces overall bad debt
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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 the provider even sees patients. Improving registration and verification processes provides the opportunity to improve revenue greatly. Some of the ways Coverage of Discovery

benefits of the front-office process include:

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

Both Front-end and Billing Staff Appreciate Coverage Discovery

Both Front-end and the billing staff appreciate our services as it helps to make their work easy and efficient. Moreover, it provides them time to focus on the things that require their utmost attention.

Efficient Registration Process

Having a more efficient registration process makes it easier for your staff to get correct information so that they can speak knowledgeably to patients. The better your patients understand their bill and financial responsibility, the more likely you are to get paid. In many cases, patients are unable to pay the cost of medical care, but knowing what’s coming and working out a payment plan can increase the part that you do collect, and keeps patients much more comfortable with the billing process.

Qualified Billing Staff

Billing staff benefit from having the correct insurer/payer information. Code matching helps to ensure the claims are approved when they are submitted. It also makes it easier to get them filled out since the appropriate codes have already been identified.