A north-central Florida, 421-bed hospital sought a second review of their primary payer service vendor’s work to learn if it had missed additional eligible claims in unidentified self-pay accounts. The hospital, which had more than 46,000 accounts identified as self-pay, wanted to establish a baseline understanding of actual coverage availability versus true self-pay status to inform financial models.
self-pay accounts reviewed
of claims over 2 years were found eligible
in payments recovered
average newly identified eligible claims
- The hospital had a high number of patient self-pay accounts.
- The hospital’s existing service based results off of eligible individual patients found, not the number of eligible claims.
- Trying to recover uncompensated care using data from eligible patients rather than eligible claims created more work and demanded more resources from the hospital.
- A thorough understanding of HIPAA and CMS regulations, security & compliance standards.
- A track record of success, finding the most claims and dollars legally and quickly.
- Speed and accuracy.
- End-to-end process management.
The hospital used eSolutions’ Insurance Discovery to conduct a comprehensive review of over 46,000, or 100% of the facility’s self-pay accounts between September 2011 and November 2013, and found 11.3% of those were eligible claims.
The return for the facility was significant and swift. A report with eligible claims data was provided to the hospital to bill within a week of receiving the initial batch file.
The final result: additional payments exceeding $2.9 million for the hospital.