Unlock Higher Revenue: 6 Tools to Instantly Maximize Reimbursement

While there is no denying these challenges, the future is promising. In 2023, more than 67%¹ of medical groups showed signs of improved operational efficiency, exceeding or meeting their productivity goals for the year. The U.S. healthcare system is also at the forefront of technological advancements, incorporating new solutions to improve patient care and treatment outcomes.

Some of these technologies are specifically designed to improve and support the revenue cycle. Best-in-class solutions are enabling providers to capture every available dollar from patient encounters, helping strained healthcare organizations continue to serve their communities with quality care.

6 Tools To Maximize Your Reimbursement Now

How big of an impact on your organization would shrinking the number of claims that are written off or sent to collections and collecting all available revenue make? Game-changing revenue cycle management (RCM) technologies can help billing professionals do just that.

Tools that automatically find, correct, and verify patient and payer information in real time help billers do more with existing resources and free up time for higher-value responsibilities. Industry-leading solution suites include powerful tools that can optimize receivables at any stage of the billing process, ensuring no payments are left on the table and reducing administrative burden.

Here’s how you can immediately increase reimbursement and what tools are available to help you do it:

1. Get Complete, Accurate Patient Data in an Instant. Faulty patient demographic data is the number one reason for denied claims and failed insurance eligibility. The right demographic verification tool can automatically enhance core data on more than 82% of patient claims, ensuring billers have complete, accurate data from the outset.
2. Locate Active, Billable Healthcare Coverage in Real Time. A best-in-class, automated insurance discovery tool can solve “coverage not found” and “inactive” errors, finding billable coverage instantly for more than 40% of self-pay claims. This includes identifying primary, secondary, and tertiary coverage — even retroactive Medicaid — and payer order.
3. Check Eligibility and Benefits in Real Time. An automated insurance verification tool can confirm all active coverage on the claim’s date of service. From service type, to co-pay and deductibles, to benefits, billers can access the data they need to verify eligibility from a single access point.
4. Implement Right-day Billing. Automated deductible monitoring tracks in real time when the patient deductible has been met to shift primary financial responsibility from the patient to payers. Billers can drop claims with precision, increasing the likelihood of receiving proper reimbursement while lightening the patient’s cost-sharing burden.
5. Offer a Personalized Approach to Self-pay Accounts. Self-pay analysis tools can build a financial profile of the patient and determine eligibility for compliant discounts and payment plans, improving self-pay collection rates by an average of 30%
6. Track Claim Progression. Automated claim status tools can run lightning-quick checks to show billers where a claim sits in the payer’s system. One click reveals whether a claim is progressing or has stalled, ensuring visibility through resolution and payment.

Used alone, each of the above tools is powerful. But when used together, they can turbo-charge billing performance and capture maximum revenue for providers.

The Sooner, the Better

While RCM optimization solutions can be used at any point in the revenue cycle, sooner is better. When applied at the front end of the billing process (or as early in the patient encounter as possible), a best-in-class solution like ZOLL^® AR Boost^® can improve statement delivery, reduce the cost of claims, and help accelerate payments.

Using the right tools (together) at the right time allows providers to face down the current challenges to providing quality services and keep their doors open. Modern RCM optimization solutions streamline the claims process to increase productivity and maximize revenue, putting billing professionals in a better position to do their jobs well and with less hassle. In short, technology offers a path to high performance.

¹2024 MGMA Provider Compensation and Production Report, https://www.mgma.com/getkaiasset/252744ee-c63b-4a96-9211-8a5d6b908b39/MGMA-2024-Provider-Compensation-Data-Report.pdf, Accessed 19 February 2025