Mastering insurance collections.

Best Practices for Mastering Insurance Collections

In the complex world of Hospital Revenue Cycle Management, the process of collecting from insurance companies demands precision, proactive measures, and a deep understanding of the complexities within the healthcare financial landscape.

About 40% of providers fail to collect over $31,713 annually: This startling statistic comes from an article from Becker’s Hospital Review, highlighting the significant revenue leakage in healthcare collections. This also points to the fact that the providers are forced to write off what should be collectible insurance balances. It also reveals the ability for the insurance companies to control the collection narrative. 

Managing your own insurance collections can be your best option. After all, it is your organization’s revenue you are protecting! This article will discuss best practices to optimize your cash collection from the health insurers.

At Sunlit Cove Healthcare, we recognize the pivotal role insurance collections play in a hospital’s financial stability. In this article, we will dive into the essential strategies and practices to optimize insurance collections, ensuring smoother revenue cycles.

Importance of Authorization and Proactive Approach

Authorization stands as the initial checkpoint in the revenue cycle. It’s crucial to obtain document authorization meticulously, adhering to payer requirements.

  • Verify the authorization number is listed on the claim
  • Check coding on the authorization before the claim is submitted
  • Use clinical expertise for complex authorizations

Being Proactive: Recognizing and Addressing Missing Information

When an insurance company does not respond, it often signifies missing or incorrect details. Here, it’s essential to investigate and identify the discrepancy. Your role is to bridge the gap by communicating the necessary information effectively. Building a network of connections within the insurance companies, understanding the best communication channels, and having a detailed cheat sheet can streamline this process.

  • Establish and adhere to follow up time frames based on dollar amount.
  • Submit missing information electronically
  • Coordinate with Clinical and Coding staff when needed.

Lori Intravichit, CEO of Sunlit Cove Healthcare, said:

Don't expect insurance companies to follow up; it's your responsibility to monitor claims closely, check the insurance portal regularly, and initiate follow-ups promptly.

Learn from Past Claims: Building an Effective Strategy

Learning from past claims is a goldmine for refining your strategy. Analyze previous claim rejections or disputes to discern patterns and potential pitfalls. Use this knowledge to prevent similar issues, fine-tune your approach, and proactively mitigate future discrepancies.

Don’t Rely on Assumptions: Verify and Persist

One of the golden rules in insurance collections: never assume a claim is being handled correctly by the insurance company until it’s fully paid. Verification, persistence, and detailed scrutiny are the cornerstones. Don’t trust blindly; verify every detail, question discrepancies, and persist until resolution.

Training and Empowering Collectors

Proper training and empowerment of your collectors are fundamental. They must possess a deep understanding of handling various situations, difficult claims, and complex scenarios. If your hospital collectors require additional training or guidance, Sunlit Cove Healthcare Consultants can equip them with the necessary skills and knowledge.

  • Effective Claim Follow up
  • Claim resolution should result in payment
  • Recognize insurance stalling and develop skills to get past the roadblocks.

It is Time to Evaluate Your Collection Practices

Are your collectors trained adequately to navigate intricate insurance claim processes? Do they possess the expertise to handle complex claims effectively? If not, it might be time to consider professional assistance. Sunlit Cove Healthcare Consultants can train and empower your collectors, enabling you to keep collections in-house and optimize your revenue cycle management.

In conclusion, mastering insurance collections is a multifaceted task that demands attention to detail, proactivity, and continuous learning. Sunlit Cove Healthcare Consultants stands ready to support hospitals in enhancing their revenue cycle practices. With our expertise, training, and guidance, hospitals can strengthen their internal collection teams, ensuring efficient and effective insurance claim processes.
For more information on how Sunlit Cove Healthcare Consultants can bolster your hospital's collection capabilities, contact us, email Lori@Sunlitcovehealthcare.com or give us a call at (727) 278-3009! Optimize your revenue cycle, empower your collectors, and elevate your financial success!

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Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.