Hospitals face a dramatic shift in the payor landscape and self-pay accounts. The Affordable Care Act’s impact on Medicaid expansion has effectively reduced the number of uninsured admissions and uncompensated care. But conversely, more patients are now enrolled in high deductible health plans (HDHPs).
Patient payment responsibility is at a new, all-time high and hospitals’ most reliable line of business with some level of reasonable margin, commercial insurance, is at risk.
Healthcare administrators and revenue cycle leadership must address new payor mix concerns, including self-pay receivables. Processes that once worked are now rendered ineffective and unreliable. Collecting from patients is different than collecting from third-party payors. It’s time for hospital billing, collections and accounts receivables strategies to adapt.
Correct patient demographic and insurance coverage data, if captured and harnessed properly, proactively improves the liquidity of every self-pay dollar—both primary pay and balance after insurance. Screening patients who either present or result as self-pay for coverage should be made a standard recurring process, not an occasional exception. Screening prior to sending accounts to collections can result in saving millions annually.
Manage the perfect storm
Payor Logic helps hospitals manage the perfect storm of changing payor landscapes, patient payment responsibility and non-payment risk. We start by obtaining accurate patient information for every visit, determining correct payor source, verifying coverage, and even discovering additional coverage for nearly all patients. Our goal is to reduce your non-payment risk—every patient, every visit, every time.
Demographic verification, payment likelihood and financial assistance screening is performed on the front-end to ensure you are collecting every possible dollar, at the lowest possible cost.
Our clients enjoy a 6:1 return on investment for their Payor Logic investment, fewer write-offs and reduced cost-to-collect. While some accounts receivables software gives you reports, our solutions give you results:
- Recognize increased revenue
- Secure reimbursement for uninsured and underinsured patient balances
- Reduce cost-to-collect
Benefits for Hospitals
Payor Logic customers discover newfound payor sources yielding faster, more successful claims submissions. Our solutions eliminate manual processes, reduce return mail and minimize risk of rejected claims. Specific benefits for hospitals include:
- Scrub self-pay and HDHP accounts for 3rd party coverage
- Quality self-pay patients for charity, hardship or presumptive Medicaid enrollment
- Verify demographics
- Obtain correct responsible party the first time
- Determine patient propensity to pay
- Expand available payor sources for more than 10% of self-pay patients
- Minimize write-offs, labor hours and collection agency expense
“Payor Logic converts our uninsured to valid, billable payer sources. Some vendors just give us reports, but Payor Logic delivers results.” Three-Hospital Health System