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Maximizing Reimbursements: Strategies to Capture Every Last Dollar

For healthcare organizations, staying nimble and optimizing collection strategies is imperative to remaining profitable. In this Q&A, David Wojczynski, President at TransUnion Healthcare, talks through why maximizing your reimbursement efforts is vital for maintaining a healthy bottom line.

Q: Why should maximizing reimbursement strategies be a top priority?

David Wojczynski: Significant reimbursements can be recovered when post-service processes are optimized and streamlined. If a typical, 350-bed hospital were to focus solely on cutting costs over improving processes, as much as $22 million could be missed annually.1 By using big data technologies, healthcare organizations have reduced costs by 10% and grown revenue by 30%.2 When reimbursement and revenue cycle leaders tackle revenue leakage holistically — through the identification of hidden insurance coveragegovernment reimbursements, and accounts receivable recovery and denial management solutions — it’s easier to ensure earned revenue gets paid.

Q: Why is it so important to look beyond self-pay accounts when it comes to insurance discovery?

Wojczynski: The lion’s share of missed coverage — up to 60% — comes from self-pay accounts. So while that’s a great place to start searching for additional opportunities, you shouldn’t stop there. Finding all hidden coverage is a complex process many vendors aren’t able to achieve because they don’t have the robust technology and tools needed to do so. Significant dollars can be found by also looking at coordination of benefits opportunities and Medicaid secondary. With the right comprehensive solution, $100s of thousands can be found annually for a mid-sized hospital and $10s of millions for a large health system.

Q: How are government reimbursements affecting healthcare organizations’ bottom lines?

Wojczynski: Medicare and Medicaid underpaid hospitals $68.8 billion in 2016 and $76.8 billion in 20173, and in 2017, accounted for more than 60% of all care provided4. Needless to say, collecting on potential government reimbursements, despite their complexity, shouldn’t be ignored. Just think, Medicare bad debt (MBD) represents a significant revenue source for hospitals — 65% of the eligible amount of MBD incurred. Plus, now there’s added pressure to correctly report uncompensated care on worksheet S-10 since 75% of the traditional Medicare DSH payment has been reallocated to the uncompensated care pool. Addressing key areas of the cost report preparation process and identifying potential underpayments can help you recover more revenue.

Q: Denials are a major pain point for providers. What are some denial management strategies?

Wojczynski: When you consider 1–5% of net patient revenue is lost to denials5 — which for an average hospital could be between $5 to $10 million6 — it’s no wonder healthcare providers are eager to close the gap between peak cash potential and actual cash generated. The best strategy for resolving denials includes powerful technology backed by industry expertise and strong data analytics to identify “true denials,” rather than spend time and money chasing false denial indicators. The ability to identify the root causes and automate the resolution process enables providers to approach denials more effectively and efficiently, as well as prevent future denials — which increases revenue recovered, reduces A/R days and lowers your cost to collect.

Learn how TransUnion Healthcare can help you turn earned revenue into revenue realized.

Sources
1The Advisory Board | 2SNS Research | 3American Hospital Association | 4Modern Healthcare | 5The Advisory Board, Becker’s Hospital Review | 6The Advisory Board | 7HFMA, RCM Answers | 8TransUnion Healthcare proprietary data | 9The Advisory Board

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