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Discover how to spot if it's time to reexamine how you're managing insurance A/R.

5 Signs Your Revenue Cycle Low-Balance Recovery Program Isn’t Working

Outsourcing aging A/R that’s below a certain dollar threshold is one way that hospitals ensure in-house staff stay focused on the most profitable areas of the revenue cycle. In fact, consultants often recommend using a business partner as a successful way to address segments of the revenue cycle with lower revenue potential at the individual account level. But not all low-balance recovery programs are created equal, and hospital revenue cycle leaders must be vigilant in evaluating their business partner’s effectiveness.


Signs Revenue Cycle Leaders Need to Re-Examine Low-Balance Account Management

How can you spot if it’s time for your hospital to consider a different vendor?

1) Your A/R Inventory Is Being Left Behind

Some business partners will work only the easiest-to-resolve accounts or limit services to a certain monetary threshold, leaving behind meaningful revenue opportunities. Untouched insurance claims often add up to 1% or more of a hospital’s Net Patient Revenue (NPR). The right healthcare revenue cycle outsourcing company won’t simply “cherry pick” your inventory but will ensure accounts are worked until underlying issues are identified and appropriately moved to the next step and will share insights to minimize the likelihood of similar delays or payment discrepancies going forward. Working this way sends an important message to payers that no segment of your revenue cycle will be ignored.

2) Payment Recovery Takes Too Long

If your business partner focuses solely only on revenue recovered, you’re leaving important areas of your revenue cycle unattended. Tracking—and successfully improving—time to resolution is key to reducing aged inventory, maintaining cash flow, optimizing ROI of partner relationships, and gaining an understanding of issues fast enough to avoid future denials or underpayments.

Efficiency is one of the biggest competitive differentiators among business partners. The right vendor will focus on minimizing touches. Instead of using rules-based systems, a strong partner will have predictive workflows that use pattern-based reasoning. Under such systems, the technology “learns” how to resolve similar types of underpayments and denials most quickly. An ability to segment and prioritize inventory this way results in much faster resolution and insights.

3) Workflows Are Siloed

How difficult is it to track progress on your accounts, identify changes in inventory, and implement systems of prevention based on root issues? The right partner will operate with transparency and use systems that integrate with your own for easy monitoring and auditing. For example, a partner that can work in parallel within the healthcare organizations’ platform, working securely within Epic, for example, makes it much easier for the hospital to view progress and make use of detailed audit trails. Making adjustments to the organization’s existing workflows based on shifts in payer behavior also becomes much easier.

4) Revenue Cycle Insights from the Partner Are Missing or Incomplete

If your business partner is simply working low-balance accounts but not giving enough meaningful insights to minimize denials or underpayments going forward, then you need to change tactics. Which is more valuable to your organization: payment on a low-dollar account or payment combined with actionable intelligence that enables your team to avoid similar issues going forward?

The ideal healthcare revenue cycle low balance partner will not only work your existing inventory but also provide frequent and detailed reporting and recommendations to address root issues. Types of reporting you should expect are placement reports, inventory reports, aging reports, month-end reports, outcome reports, closed reports, and payment reports. In addition, you need a partner that will not only mine your organization’s data to show payer trends, gaps, and root sources of underpayment and delay but also provide guidance on the best ways to address them.

5) Customer Service Is Defined Narrowly

Having a business partner that’s easy to contact isn’t enough. You should feel like you have a partner when addressing payer issues. A successful partnership involves the partner working collaboratively with the hospital's revenue cycle team, coordinating efforts to achieve the best outcomes for the hospital.

The right customer service also means the partner is continually innovating, bringing the latest technology and tactics to the revenue cycle team. In a strong relationship, the partner will share not only insights observed for the organization but also advice on best practices gleaned from successes across similar peers and other payers. True support is offering evolving strategies and recommendations with a “bird’s eye” view.

Improving Low-Balance Insurance Claims Reimbursement

If you suspect you aren’t getting enough value out of your low-balance recovery program, connect with a rep from Knowtion Health ( today. Our team can provide detailed analysis and insights to help you determine the right low-balance threshold for your organization and ways to optimize low-balance account resolution and revenue recovery.