Recovering hard-earned, lost revenue is a critical challenge for hospitals. According to Sage Growth Partners, one-third of hospitals report over $10 million in bad debt annually. Adding to the complexity are ever-changing regulations and mounting appeals/denials. Lost revenue adds up to strain your organization—not to mention the downstream impact of providing quality care in your communities. Whether you’re rethinking some of your recovery processes or considering a complete overhaul, here are 4 common mistakes and how they can be resolved.
1) Not taking advantage of ERISA law:
The Employee Retirement Income Security Act (ERISA) has existed for nearly 50 years, but most hospitals are unable to dedicate the time or workforce to file an ERISA appeal properly. ERISA sets minimum standards for most voluntarily established retirement and health plans in the private industry to protect individuals in these plans. ERISA law can be leveraged when reimbursement is lower than expected, and other appeals have been unsuccessful.
How can hospitals start taking full advantage of ERISA law? We suggest hiring a dedicated ERISA firm, Auraven Health, to handle these special appeals. These specialists have the knowledge and process to discover which claims might be impacted by ERISA and file the appeal. This ensures that hospitals get the maximum benefit reimbursement or recovery for denied benefit claims.
2) Billing and Collections Mistakes:
When hospital systems don’t have an effective billing process, it comes at high cost – the consequences of which are magnified as reimbursement declines and overhead increases. High-deductible insurance plans are becoming more common, leaving a greater out-of-pocket cost on the patient. If the patient is uninsured or underinsured, there is no guaranteed method of payment for the hospital.
Hospitals need to collect the right information the first time at the point of service while patients are still on the premises. Additionally, hospitals will benefit from designating a patient financial advocate and evaluating if staff are setting realistic expectations about what is covered by insurance versus out-of-pocket costs. This lessens miscommunications between hospital staff members and patients.
3) Poor Monitoring of the Claims Process:
Monitoring the claims process is a crucial part of recovering lost revenue. Not all medical bills are paid on time, and it can take up to 90 days for insurance companies to pay out claims, so hospitals need ways of following up with patients who have not made payments or disputed charges. Unfortunately, patients may not even know there was an outstanding balance that needed payment or could not find the right person within the hospital system by calling billing services departments directly. Hospitals should consider hiring outsourced collections agencies that are dedicated to monitoring claims. It’s imperative to monitor the claims process from beginning to end to understand why a claim was denied or can catch billing errors and coding issues.
4) Lack of Technology:
Many hospitals make the mistake of not having adequate technology solutions in place for monitoring and recovering revenue. Consider employing an automated system that regularly contacts patients with outstanding balances or automatically creates payment plans after insurance has been denied coverage without human intervention. These issues can be reduced significantly since marketing automation offers a solution that reduces the chance of human error and frees up time for staff.
Recovering Lost Revenue -Next Steps
If your hospital needs to recover lost revenue, you are not alone. Share these suggestions with your team to start the conversation.
For a dedicated ERISA law partner, reach out to the team at Auraven. Auraven offers untapped solutions to help hospitals regain much-needed revenue, and we do it while ensuring every bit of information remains safe and secure. By using the federal ERISA appeal, it will ensure maximum benefit reimbursement or recovery for denied benefit claims.