“We wanted the right technology that could look for insurance coverage for self-pay patients without the need for us to increase our manpower. The cost savings were a big win for the department.”
— Brent Rikhoff, Director of Pre-Access, UCHealth
Challenge
UCHealth is an integrated health system with a network of 12 hospitals and more than 30,000 employees. At the height of the COVID-19 pandemic, UCHealth maintained its commitment to an excellent patient experience by giving all patients access to tests and vaccinations. Costs for uninsured and self-pay patients could be recovered under the Health Resources and Services Administration’s (HRSA) COVID-19 Uninsured Program (UIP), but only after confirming that the patient had no relevant active coverage. If they missed this step, UCHealth would be landed with bad debt, increasing collection costs and unwanted audits: they needed a reliable way to track and verify insurance coverage accurately and in real-time.
Solution
UCHealth chose to use Coverage Discovery® after experiencing positive results with Experian Health’s Eligibility solution. Coverage Discovery allowed them to scan the entire revenue cycle for billable commercial and government coverage that patients may have been unaware of or forgotten about. The tool gave UCHealth access to Experian’s proprietary databases, including employer group mapping and patient search history, so they could track and verify potential coverage in multiple locations. This made it much easier to find insurance information for plans without a self-pay search feature.
After seeing positive results, UCHealth expanded their use of Coverage Discovery to self-pay and emergency department patients. This helped them root out discrepancies in patient accounts and prevent accounts from being misclassified as bad debt or charity. Uncovering additional active coverage was also a major benefit for patients.
Outcome
Thanks to Coverage Discovery, UCHealth achieved the following results:
- Over $62 million in insurance payments in 2022, a 25% increase from 2021, includes payments from their top three payers
- $45 million in coverage found between May 2022 and May 2023
- Over $3.5 million in collection costs savings in 2022
Overall, Coverage Discovery has helped UCHealth create a more streamlined approach to verification and billing. The batching feature made it easy for staff to process the backlog of patient accounts awaiting insurance verification, while access to large, current datasets facilitated more accurate billing.
Director of Pre-Access at UCHealth, Brent Rikhoff, said the ability to integrate Coverage Discovery with Epic® enabled the team to achieve proper reimbursement for services rendered. Expanding the solution to include Medicaid coverage identification would be an obvious next step for UCHealth, following this impressive return on investment.
Learn more about how Coverage Discoveryidentifies missing and forgotten billable coverage, so healthcare providers can get fully reimbursed while maintaining an outstanding patient experience.
