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re|search

Unidentified Payer Search

Overview

At the point of registration, obtaining accurate demographics can often be a challenge. Even with today’s sophisticated software platforms, patient data accuracy can easily be compromised by human error. re|search rapidly matches patient records to previously unidentified third party payers. Identifying, correcting, and billing the claims which other automated third party payer validation services miss. 

Challenge

The portion of accounts receivable that is classified as patient responsibility is growing. The poor economic environment, job losses (with accompanying loss of employer provided insurance) and the overall climate of patients frequently changing insurance cause many patients to arrive at a facility with a lack of insurance information. When the patient lacks the appropriate insurance information, the claim generally ends up in the self pay bucket.

In our experience, from three to five percent of the claims within the patient responsibility bucket are actually covered by third party insurance. The majority of these misclassifications relate to Medicaid, but there are also many Medicare and commercial insurances that are unidentified. This misidentification results in frustration to both the patient and the facility.

Solution

Using proprietary data mining technology that does not replace other Medicaid eligibility or collection agency solutions, the re|search program continuously mines your registration information retroactively and proactively searching for insurance programs that will cover patient responsibility balances due. In addition, the technology will find additional DSH days that can be used to recover additional monies through amended cost reporting. 

re|search works because it is done strictly on a contingency fee where dollars are paid only on found dollars and not on a per search basis. Once the claims are determined to be eligible, re|solution will return the accounts to be billed to the hospital for billing or re|solution can bill the claims on the hospital’s behalf.

The hospital experiences additional dollars from self pay accounts, reduced costs of chasing accounts that are misclassified and increased patient satisfaction.

Results

Let us help you increase your reimbursements as we have for our clients listed below:

Hospital System - $800,000 recovered

120 Bed Hospital - $200,000 recovered