Financial Risk Assessments Can Diagnose Revenue Leaks

Gonzales and his team started out by looking at a kiosk solution—software that’s intended to lower costs while maintaining a high level of interaction with customers and employees. The system they considered used patient IDs at check-in and for the insurance eligibility and co-pay estimate, however they weren’t convinced it was the best choice for their patient base. They wanted a system with real-time eligibility verification software which would also work with their existing scheduling software. They opted for the Duluth-GA-based Navicure, an Internet-based medical claims clearinghouse, which they took live at RAS as of February.

The new system runs the patient schedule three days prior to examination and determines eligibility. For walk-ins, staff is able to use a single website to check the patient’s insurance eligibility. Within the first three months of addressing the eligibility issue, RAS saw a 56% reduction in errors, Gonzales says.

“The new software only helped us accomplish 80% of our goal,” Gonzales says. “We also dug more deeply into our denials.”

That’s when their financial risk assessment really enlightened—they found another $100k in drug reimbursements that hadn’t been paid. “We run a pretty tight ship at RAS so for years we haven’t done a risk identification project as it pertains to revenue cycle,” he says. “But this is about making sure we are getting paid what is owed in our contracts.”

There are a lot of changes taking place due to healthcare reform and the economy, and many healthcare financial leaders are grappling for any way to minimize their financial exposure and that means assessing risks. As the payment environment changes in the coming years, healthcare facilities must become extremely adept at identifying, measuring, monitoring, and eliminating their risks or they may lose greatly needed revenue.