Low Balance Insurance Recovery Solution

Powered by ClaimBrain® Advanced Analytics


The Challenge:

Health systems lose up to 1% of Net Patient Revenue (NPR) from low balance third-party-payer accounts.

That’s because keeping up with the sheer volume of these accounts is not economically viable for many health systems. With an internal solution only, many low-balance accounts with recovery potential go unworked and written-off.
To address the low balance challenge, many health systems outsource these accounts to low-cost, and often off-shore, vendors. But this is a “solution” in name only, since cheaper labor only enables these vendors to work down to marginally lower balances – they never get ALL the NPR opportunity.

The Opportunity:  Up to 1% increase in Net Patient Revenue

 

The Solution:

The ROI below reflects the actual results for a health system with $1.6b of NPR using a Low Balance Program with RSource’s propietary ClaimBrain® Advanced Analytics

Only a technology-enabled solution that uses advanced analytics to automate activity on the majority of accounts, while focusing staff on the remaining inventory, can generate maximum ROI.


How it Works – Advanced Analytics & Robotic Process Automation (RPA)

ClaimBrain’s advanced analytics use algorithms to triage accounts into four categories:

  • RPA – No Collection Opportunity (40% of accounts)
    Algorithms apply appropriate adjustments using codes that detail why claims were uncollectible. RPA closes accounts in hospital system with specific codes.
  • RPA – Simple Fixes (20%)
    Algorithms identify claims needing simple fixes, like transferring balances or re-billing. RPA moves these claims in the hospital’s system.
  • Manual Work (with “Hints”) (25%)
    Algorithms identify accounts needing manual work but provide “Hints” for next action needed (like send appeal or get authorization number), substantially increasing productivity.
  • Manual Work (15%)
    These claims require manual review.