Catching Misclassified Accounts Early Pays Off

October 22, 2013 by Minda McMann

Sometimes it’s all in the cards. And, in the end, it’s usually not a winning hand for the healthcare organization.

In this case, the “card” is the patient’s insurance coverage and the “hand” is the increasing amount of bad debt that can be avoided. For example, a patient presents his or her insurance card at registration. The patient’s employer recently changed plans, and the patient mistakenly pulls out the card for the old plan. The claim is processed using the expired insurance information, and the payer rejects it and reclassifies the account as self-pay. After a time, the account goes to collections, and the patient is sent letters and receives collections calls. Both are ignored because the patient has coverage and assumes the provider simply made a mistake. Unable to resolve the issue, the provider ultimately writes the account off as bad debt.

When accounts like this one are misidentified, the healthcare organization loses revenue, time and patient satisfaction. Misclassifying accounts can happen because of registration errors, changing insurance or patient miscommunication. When an account is misclassified, it increases the likelihood the account will turn into bad debt, especially when the account is misclassified as self-pay. Even when caught during the collection process, misclassification errors can impact A/R days, payment speed and cash flow.

So, how do you play your cards right? Using the most up-to-date payer data, healthcare organizations can systemically search for current commercial, Medicare and Medicaid insurance coverage. An automated process reveals and prioritizes potential active coverage, allowing staff to rectify any mistakes and file claims in a timely manner. Staff can even proactively identify and correct routine data entry errors, such as incorrect birth dates or transposed Social Security numbers, before the claim is submitted.

While the organization improves cash flow and productivity, there also are patient benefits. Using data to identify the right insurance coverage upfront makes patient interactions more efficient. In addition, reduced payment misunderstandings and unnecessary collections calls drive overall patient satisfaction.

Curious about how your organization can have a winning collections hand? Use data and analytics to improve the accuracy of upfront business processes and enhance the patient experience. Learn about one of our newest products, Self-Pay Coverage Finder℠, and see how automating the search for insurance coverage can positively impact your organization’s bottom line and the patient’s experience.