5 tips for identifying whether self-pay patients have hidden health coverage

As hospitals and health systems seek to decrease bad debt and maximize reimbursement, it is crucial they identify which patients are true self-pay and which patients are self-pay after insurance, meaning they have a high-deductible plan and still owe a significant amount of money after their coverage kicks in.

Patients who initially present as true self-pay do not always remain in that category, as they may purchase health coverage or become eligible for Medicaid benefits. However, hospitals and health systems must make sure they're aware of these changes, even when the patient forgets to update their information.

Detecting hidden coverage is especially important considering collection rates for true self-pay accounts are lower than those for SPAI accounts. A recent Crowe Horwath analysis found true self-pay patients generally pay 6.06 percent of what they're billed, while SPAI patients generally pay 15.51 percent of their total bill.

Ric Sinclair, vice president of product at ZirMed, a provider of cloud-based revenue cycle software and predictive analytics, says it is vital for hospitals and health systems to make sure they're being paid appropriately in today's healthcare environment. There's uncertainty in healthcare because of ongoing reform efforts, but Mr. Sinclar says there will continue to be hidden insurance coverage for providers to find due the increasing popularity of high-deductible health plans.

Here, Mr. Sinclair provides five pieces of advice for healthcare organizations that seek to detect hidden coverage.

1. Leverage organization data to ensure good patient visibility across care continuums. Mr. Sinclair says hospitals and health systems should implement technology and processes that allow them to see if they've treated a patient before or if the patient is in their network or an affiliated provider's network. That way "you're ensuring minimal data loss and maximizing visibility across the continuum of care," says Mr. Sinclair. "That requires a different way of thinking at many healthcare organizations."

2. Establish a proactive registration and check-in process. Hospitals and health systems need a modern registration and check-in process "that extends to online before patients walk in the doors, to where you are completing pre-authorizations and patient access steps including registration very proactively," according to Mr. Sinclair. By establishing a proactive registration and check-in process, hospitals and health systems will be more likely to proactively identify patients who present as true self-pay but are in fact self-pay after insurance.

3. Conduct a market build vs. buy analysis. Mr. Sinclair says healthcare organizations should also conduct a market analysis of solutions that detect hidden coverage because human process and intervention won't catch everything. "You have to understand the technologies that are out there. There are technologies out there that do everything from basic Medicaid verification rules to advanced predictive analytics that can mine data to proactively find coverage for patients. The technology available right now is incredibly powerful for streamlining processes and optimizing revenue — quickly and effectively," he adds.

4. Leverage technology to understand someone's propensity and probability to pay. Regardless of whether hidden coverage is detected, Mr. Sinclair says hospitals and health systems should look at patients' propensity to pay and how the organization should engage with patients to secure payments. That means identifying patients' preferences, including whether they respond best to a text message, an electronic message such as email, or a properly timed and easy to understand patient statement. Provider organizations can also conduct analyses to determine the number of statements that should go out to each patient and when the statements should be sent to achieve the highest payment as quickly as possible.

5. Offer many flexible payment options. "If someone is self-pay or if someone has been identified as having insurance on a high-deductible plan, offering things like the ability to store their credit card or bank account information to process an automatic and flexible patient centric payment plans, is vitally important," says Mr. Sinclair. He noted patients also generally want easy-to-use landing pages or portals when they go online to pay their bill, along with concise statements that are easy to understand. "All of those things are incredibly important to do and really the tip of the iceberg when looking at best practices to collect from patients and for finding insurance coverage," he says.


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