Published: Jul 07, 2023
Revenue Cycle Management

Insurance Discovery Software: Why You Should Detect Coverage with Technology

Rex H.
Rex H.
8 minute read
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With bad debt increasing in healthcare, insurance discovery software has become more valuable in revenue cycle management.

What Is Insurance Discovery Software and Why Should You Use It?

Insurance discovery software is a tool designed to find hidden or unreported insurance coverage, thereby ensuring maximum claim reimbursement and reducing instances of uncompensated care. It accomplishes this by utilizing best-practice search methods, a variety of proprietary databases, and historical data to conduct a comprehensive scan from the point of pre-service through the entire accounts receivable (A/R) lifecycle post-service.

Automating insurance discovery can reduce staff stress and effort, save time, and decrease bad debt. Insurance discovery software is a valuable tool for improving efficiency and revenue cycle management.

Common Features of Insurance Coverage Discovery Tools

Insurance discovery software may have some of the following features.

Real-Time Insurance Coverage Detection

Once effectively implemented, your organization will benefit from streamlined administrative processing. The system automatically checks each patient's insurance coverage and eligibility. Your staff is spared the repetitive and error-prone manual data checks. 

Instant insurance coverage detection can save an average of 14 minutes per transaction, translating into a significant time-saving opportunity for your staff. Insurance discovery automation has the potential to save $12.8 billion for the medical industry.

Batch Workflows

An insurance discovery software with this feature verifies multiple patients together and checks more than one payer at once for coverage. This allows the discovery of coverage that the primary insurer may not offer but is available from others. 

Batch workflows allow your staff to process eligibility more efficiently, saving your staff time and boosting productivity.

Integration With EHR and PM Systems

Your organization probably already has practice management software and an electronic health record system. It is helpful for your insurance discovery software to integrate with your existing systems to avoid manual entry of data and the errors that result from it.

Streamlined Self-pay Scrubbing

You can automate the scanning of self-paying patients without insurance before delivery of service. Some software can even scan patient balances in accounts receivable for coverage up to 90 days post-service.

Benefits of Insurance Discovery Software

Maximize Reimbursement

Increased coverage discovered by your software can impact your revenue positively. A large health system with more than 40 hospitals and 800 physician practices implemented a multi-vendor coverage discovery model and found significant benefits. Their monthly reimbursement from accounts coded by the new, upfront processes increased from $1.72M to $1.77M per month. During the same period, average reimbursements increased from an average of $874K to $919K per month.

Reduce Bad Debt

Insurance discovery software reduces bad debt by uncovering hidden insurance coverage, enabling healthcare providers to collect payment directly from insurance companies rather than attempting to get patients to pay everything out of pocket, thereby reducing the risk of unpaid bills and write-offs.

Provide a Better Patient Financial Experience

By identifying coverage that patients were unaware of, insurance discovery software can significantly decrease, or in some cases, eliminate, the amount they have to pay out-of-pocket. This reduced financial burden can be a major relief for patients, particularly those facing expensive treatments or procedures.

Better Staff Productivity 

Insurance discovery software allow your staff to utilize their time and effort best. Staff will no longer have to resort to manual self-pay scrubbing and can rely more on automatic workflows. Staff can also prioritize accounts most likely to be re-billable to payers.

Cost of Insurance Coverage Discovery Solutions

Pricing for insurance discovery software is typically predicated on the volume of patient encounters a healthcare organization serves. More patients served means more discovery that needs to be done. Therefore, larger organizations like health systems will pay more than a smaller practice.

What To Look For in an Insurance Discovery Software Vendor

Medical billing and reimbursements are challenging in the current era. Look for a vendor that has worked with thousands of healthcare providers and facilities and has the experience of hundreds of thousands of patient encounters. 

Your insurance discovery software vendor should provide a solution that integrates seamlessly with your existing practice management software and electronic health records (EHR). The software must have proven abilities to improve the patient experience, enhance your workflow by automation, and improve reimbursement.

Do They Go Beyond Primary? Look For Secondary and Tertiary Coverage Support

Your insurance discovery software should not stop looking after the first insurance listed. Looking into secondary and tertiary insurance can lead to coverage discovery that allows you to provide the service needed by the patient while ensuring reimbursement. Such insurance discovery identifies billable coverage even the patient is unaware of and enhances reimbursements.

Insurance Discovery Software vs Insurance Verification Software

Insurance discovery software and insurance verification software, while both integral to the healthcare revenue cycle, serve different but complementary purposes.

Insurance Discovery Software primarily focuses on uncovering hidden or previously unidentified insurance coverages, including those from Medicaid, Medicare, and commercial insurers. It identifies billable insurance coverages that may have been overlooked or neglected. This process aids in maximizing insurance reimbursement revenue and reducing bad debt.

On the other hand, Insurance Verification Software is designed to confirm a patient's insurance eligibility and benefits before services are provided. It verifies the validity of the patient's insurance coverage, ensuring that the services to be provided are covered under the patient's plan. This verification process can include checking the patient's policy status, deductibles, out-of-pocket expenses, plan exclusions, prior authorization requirements, and more. This software helps reduce claim denials and rejections due to coverage issues, contributing to more efficient billing processes and improved patient satisfaction.

In summary, while insurance discovery software helps uncover unknown insurance coverages and maximize revenue, insurance verification software focuses on verifying existing insurance details to ensure coverage and minimize claim issues. Both are crucial components in a robust and efficient healthcare revenue cycle management system.

Automate Insurance Verification and Related Processes with MD Clarity

If you're looking for a solution that emphasizes insurance verification instead of insurance discovery, MD Clarity's Clarity Flow software can streamline insurance eligibility verification and more. Get a demo to see how we can help automate workflows for your healthcare organization, simplifying the process of confirming patient insurance details and providing coverage estimates at scale.

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