Automated Coverage Detection: Are Manual Processes Hurting Your Revenue Cycle?

What does coverage detection look like at your practice? If it involves staff manually processing claims and managing coverage, it may be costing you and your patients time and money.

Billing the wrong coverage, racking up uncompensated care, and relying on manual processes adds up and hurts your cash flow. Automated coverage detection helps your practice more effectively bill patients, even those who may not know what coverage they have.

Discover how automated coverage detection can boost your bottom line, improve your revenue cycle, and build a better experience for your practice staff and patients.

The difference automated coverage detection makes

Often times, claims can be submitted with inaccurate coverage details, which can be caused by error or even confusion from the patient. Tracking this coverage manually can be a tedious process that is costly and slows down your revenue cycle. This inefficient process is also subject to human errors and a higher likelihood of overlooked billable coverage.

Meanwhile, hidden coverage is a leading cause of denials, which further perpetuates days in AR and bad debt. When patients don’t have insurance, much of what they owe is never realized, impacting your bottom line. However, up to 40% of self-pay patients unknowingly have full or partial coverage. Identifying this coverage benefits you while also supporting your patients.

How does automation help?

Automated coverage detection improves your practice’s efficiency, identifies more coverage, and improves your bottom line.

Automation reduces the burden of manual workflows on your staff, freeing them to focus their attention on more pressing, human-oriented matters. Additionally, boosting efficiency and streamlining workflows causes faster collections and fewer denied claims.

Automated insurance detection uncovers hidden coverage quicker, easier, and more cost-efficiently than manual processes. By batching an automated search for coverage, collection costs decrease, and the percentage of revenue billed to payers is maximized. This is important because it typically costs 50% less to collect from payers than from patients.

This also benefits patients because it educates them about their coverage and reduces attempts to collect money that has been incorrectly identified as patient responsibility.

What kind of coverage do patients have?

From self-pay to Medicaid, many patients unknowingly have full or partial insurance coverage that remains unknown. This negatively impacts your practice’s days in AR and cash flow by impeding collections, increasing bad debt, and causing unnecessary charity write-offs.

For example, about 19% of Americans rely on Medicaid. However, many times, Medicaid gets billed when other coverage actually exists. This causes the claim to get rejected after your organization has already spent time and money submitting the claim; it also negatively impacts the window to refile, which can hurt your revenue cycle twofold.

Similarly, many patients who identify as self-pay or charity impact the amount of uncompensated or unpaid care that your practice sees. This directly hurts profit margins and overall revenue.

How does automated coverage detection work?

As a whole, patients are 40% less likely to pay once they leave the building.  Thus, no matter their point of entry, it is vital to identify and confirm hidden coverage before or at the time of service, so your practice increases collections and improves cash flow.

Automated coverage detection takes the burden off of medical practices and finds hidden or unknown coverage for them, confirms active coverage automatically, and collects accordingly, so your practice can increase collections and reduce bad debt.

Solutions with high hit rates, vast claims databases, and payer connections help identify more coverage. Finding active, billable coverage helps:

• Reduce uncompensated care
• Minimize write-offs and bad debt
• Improve revenue and profit margins
• Relieve financial burdens placed on patients

Choosing a vendor that accomplishes these goals is a direct driver of a stronger revenue cycle for your practice.

Benefits of the right coverage detection solution

Feeling ready to automate your coverage detection? The partnership between NextGen Healthcare and Waystar is designed to support practices in easily detecting unknown coverage, boosting collections, and driving revenue.

By leveraging their payer connections, proprietary algorithms, and claims database, the Waystar Coverage Detection platform yields a 30 - 40% hit rate and confirms 2.8x more coverage than other vendors. With over 1,200 payer connections, Waystar uncovers more active, billable coverage so your practice sees more profit.

Benefits for practices & patients

By helping patients understand their coverage, you not only alleviate their financial burden, but you also build their trust and support their care. Positive, attentive staff coupled with a transparent financial experience makes patients more likely to return to seek care in the future, fueling a strong patient journey.

Refresh your revenue cycle

Automated coverage detection is a part of the future of revenue cycle management. Get your practice ahead of the curve now and begin enjoying the benefits of hassle-free claims processing and a strong cash flow.

If you’re interested in learning more about our platform, connect with a member of our team.