Low Balance Insurance Recovery Solution

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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 are not analyzed and are written-off.

To address the low balance challenge, many health systems outsource the collection for 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 reflects the actual results for a health system with $1.6b of NPR using a Low Balance Program with RSource’s proprietary ClaimBrainTM 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. ClaimBrainTM uses a combination of computer and consulting services to increase NPR.


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

ClaimBrain’sTM advanced analytics and RPA consulting and computer services use algorithms to triage accounts into four categories:

  • RPA – No Collection Opportunity (40% of accounts)
    Algorithms apply appropriate adjustments using codes that detail why health insurance claims were uncollectible. RPA closes accounts in the hospital system with specific codes that are recognizable to our intelligent software bots.
  • 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 consultation but provide “Hints” for next action needed (like send appeal or get authorization number), substantially increasing productivity and eligibility.
  • Manual Work (15%)
    These claims require manual review and consultation.