The Health Resources and Services Administration (HRSA) recently ended its COVID-19 Uninsured Program (UIP), meaning that providers can no longer seek reimbursement for COVID-19 testing, treatment and vaccine administration for uninsured patients. Evidence suggests that there could be new infections in the fall and winter, which means the need for testing and treatment has amplified. A $10 billion COVID-19 funding proposal that followed this program is also being held up in Congress, which means that it can take much longer before funding is provided. While this bill may eventually be approved, it is unlikely to include uninsured Americans. This means healthcare organizations must be extra vigilant to find missing insurance coverage for COVID-19 care.
The challenge is broader than the end of the UIP program. Continuous Medicaid enrollment will also come to an end when the pandemic is no longer considered a public health emergency. Providers will need to resume eligibility and renewal checks, which will cause massive disruption as millions of individuals potentially lose coverage. In the face of reduced reimbursements, providers may have no choice but to turn away uninsured patients or absorb care costs themselves. But there is a third option – to check for missing and undisclosed coverage and maximize opportunities for reimbursement throughout the patient journey.
This can be resource-intensive if not implemented strategically. It often requires a major investment of staff time and effort, which many organizations can hardly afford, as a result of staffing shortages and larger financial pressures. However, with the right data, automation and coverage discovery strategies, providers can maximize available reimbursements and minimize disruption, without eating up staff resources.
Here are 4 strategies to find missing insurance coverage and increase reimbursement as COVID-19 funding ends:
Run continuous checks for missing coverage
As churn increases gaps in coverage, providers must perform due diligence to find coverage for their patients. Many patients have forgotten or undisclosed coverage; however, tracking it down can be an administrative nightmare. It requires staff to run multiple checks of public programs and disparate payer networks, with no guarantee that coverage will be found. With such huge changes to the Medicaid landscape on the horizon, manual checks are not an option. Providers must find an efficient way to check coverage for patients who need COVID-19 testing and treatment, or for those who may be losing government coverage.
Experian Health’s Coverage Discovery uses advanced data analytics and automation to help providers locate hard-to-find coverage, without placing an undue burden on staff who are already under immense pressure. Coverage Discovery uses millions of data points and sophisticated confidence scoring to comb through government and commercial payer databases, eliminate write-offs and speed up reimbursement. It automatically runs checks before the patient comes in for care, at the point of care, and post-service. This ensures that if the patient’s coverage status changes during their healthcare journey, potential reimbursement opportunities won’t slip through the cracks. This solution helped identify previously unknown billable insurance coverage in more than 27.5% of self-pay accounts in 2021.
As churn increases gaps in coverage, any forgotten coverage must be found. Experian Health’s white paper reveals more about how Coverage Discovery allows providers to find missing insurance coverage, increase reimbursements and avoid uncompensated care.
Verify coverage as early as possible
Federal funding during the pandemic required states to expand Medicaid support, leading to an unprecedented 85 million enrollees. As emergency support winds down, state Medicaid agencies will have one year to check the eligibility of each individual and notify those who no longer qualify. With each check taking around two to three months to complete, agencies and providers will need robust workflows to maximize capacity and communicate with patients. A KFF survey in March 2022 found that only 27 out of 50 states had plans in place to address eligibility redeterminations and disenrollments once continuous enrollment ends.
Access to reliable datasets and automated software can help providers confirm patient contact details and continue checking for coverage as patients transition from one plan to another. Should coverage be found, providers then need to verify that planned treatment or services are eligible for reimbursement and determine the patient’s financial responsibility. The sooner this can be done, the more likely it is that bills will be settled.
Experian Health’s Insurance Eligibility Verification solution can be part of the strategy to streamline eligibility checks and verify active coverage earlier in the billing process. This continuous, automated workflow uses real-time data to drive higher reimbursement rates so that providers can focus on providing the best care for their patients.
Get patients onto the right plan to increase rapid reimbursement
In many cases, government and commercial coverage only cover a portion of a patient’s medical bill. If more patients are responsible for a greater portion of costs – whether for COVID-19-related care or otherwise – there’s a higher risk of delayed payments. Confusion over federal funding or changing Medicaid coverage could compound this. Providers can improve recovery rates by assessing a patient’s ability to pay early in the process, and quickly steer them toward the right financial pathway.
Patient Financial Clearance determines which patients are more likely to pay and connects others to payment plans and financial assistance programs, so collections teams know where to direct their resources. Not only does this improve workforce efficiency and avoid missed reimbursement opportunities, but it also means that fewer patients will have to miss out on necessary care because of ambiguity over how it will be funded.
Optimize collections to direct resources to the right accounts
Another way for providers to protect their revenue once federal reimbursements end is to optimize the collections process. Collections Optimization Manager helps providers adopt a targeted collections strategy, to focus on accounts with the highest likelihood of being paid.
Novant Health used Collections Optimization Manager to automate patient collections for a faster, more efficient and more compassionate collections experience. This collections technology allowed the team to tighten up patient segmentation, allocate staff resources more efficiently and keep a closer eye on agency performance, leading to a 6.5% recovery rate and a 5.8% increase in unit yield year-over-year.
Learn more about how Experian Health’s Coverage Discovery solutions can help providers find missing insurance coverage and secure higher reimbursement rates as pandemic support programs come to an end.