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Insurance Coverage Discrepancies – Hidden Insurance/PayerDifficulty: Moderate // Patient Financial Services
Why run this play?
By reallocating incorrectly classified self-pay accounts to the patient guarantor’s appropriate payer (whether Medicaid or other insurance backed payers) you can reduce bad debt expense and achieve improved reimbursement and A/R liquidity.
Background
When you continuously identify and monitor patients/guarantors who were potentially misstated as self-pay, you ensure the correct payers are being billed and reduce unnecessary re-work. This helps you expedite insurance updates and resubmit claims to the correct carriers. For similar dates of service, patients/guarantors should typically have the same insurance on file. We have found that roughly 2 to 5% of our clients’ self-pay dollars are triggered for investigation for this play.
Take Action
- Isolate all your self-pay patients.
- Join your self-pay patients to the full ATB dataset and find any matches on MRN (or unique identifier) where the primary insurance <> self-pay within a similar time period.
- Verify payer eligibility on all qualifying accounts and re-submit misclassified self-pay accounts to the appropriate payer.
Want to see how to run this play in VisiQuate?
Request a demoHow to Calculate This Play's Value
- Identify the date the account was flagged with a potential hidden insurance issue.
- Sum all insurance payments where the payment posted date is > identification date.
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