Challenge: Manual coverage identification can’t keep pace with growing self-pay volume
With healthcare costs continuing to climb, many patients are struggling to afford the cost of care, forcing health systems to spend time chasing self-pay collections or risk bad debt. Rising patient volumes further compound the issue. For large health systems, identifying coverage up front is critical, but complicated. Active insurance benefits are often incomplete or unknown, and many organizations lack the technology to quickly find and verify coverage.
“My dollars are high, my self-pay is high, my bad debt is high and growing. We needed another way to handle the volume because adding people was not an option.”
Also ReadCindy Samuels, Senior Manager for Patient Revenue Services at St. Luke’s
St. Luke’s University Health Network found itself with a long list of patient accounts in collections. With 16 hospitals, 350 outpatient facilities, 220 physician locations and 25 urgent care centers, call center staff were bogged down making up to 30,000 collections calls a month, often without success. And growing patient volumes added to the mounting pressure facing St. Luke’s.
To further complicate collections, St. Luke’s still relied on manual coverage checks that were often error-prone, outdated and time-consuming to use. As a result, the health system discovered that many self-pay accounts labeled as self-pay weren’t actually self-pay and stood to lose out on millions of dollars in potentially billable coverage. With patient volumes climbing, St. Luke’s was close to reaching a breaking point and facing serious financial risk. St. Luke’s needed a better way to find missing coverage before accounts hit collections, but couldn’t add more headcount or disrupt the overall patient experience.
Solution: Turning hidden coverage into measurable financial return
For St. Luke’s, the first step to replacing its error-prone coverage discovery process was finding an automated solution that could check for active benefits in real time—without a heavy lift from staff. After a positive experience with Experian Health’s Collections Optimization Manager, the organization turned to Experian Health again for a solution and implemented Coverage Discovery®, which looks for previously unknown coverage on self-pay accounts.
Coverage Discovery easily integrated with St. Luke’s back-end workflows. It automatically reviews self-pay accounts, returns them to appropriate billing paths when needed, and helps St. Luke’s catch and correct insurance mistakes before accounts head to collections. And when used in tandem with Collections Optimization Manager, St. Luke’s can now easily separate true self-pay accounts and prioritize accounts with a strong likelihood of payment.
“Coverage Discovery gives us a safety net to find coverage before we send a bill or push an account to collections.”
Cindy Samuels, Senior Manager for Patient Revenue Services at St. Luke’s
Results
| KPIs that matter: |
| – $19 million in billable coverage identified in 12 months |
| – $4.2 million in incremental cash collected |
| – Flat call volume, despite 14% uptick in uncovered insurance on “self-pay” accounts |
Within a year of implementing Coverage Discovery, St. Luke’s uncovered over $19 million in billable coverage in previously labeled “self pay” accounts. This translated into more than $4 million in incremental cash collected without adding headcount or new collections efforts.
Eliminating “but I have insurance” calls now saves St. Luke’s around $200,000 each year, and collections teams also have more time to spend on high priority accounts. And St. Luke’s reports that call abandonment rates have steadied at 1.54%, far below the 7% industry benchmark.
Coverage Discovery also helped St. Luke’s improve its front-end operations and reduce the need for back-end edits, adding further revenue cycle efficiencies. Leadership now uses data from Coverage Discovery to identify patterns of incorrect or missing insurance information, pinpoint issues in front-end processes that lead to the errors, and take steps to implement systems to improve front-end data quality.
“Bringing data and reports to registration leaders from Coverage Discovery is more effective than saying, ‘you missed a lot of insurance’. I can show them what can actually be found and build processes to catch that at registration rather than on the back end.”
Cindy Samuels, Senior Manager for Patient Revenue Services at St. Luke’s
Looking forward: Protecting revenue from shifting coverage patterns
With Coverage Discovery, now in place, St. Luke’s has a predictable and more resilient self-pay strategy able to keep up with mounting reimbursement pressures, ever-evolving shifts in coverage and growing patient volumes. No extra staff needed. For St. Luke’s, Coverage Discovery delivers a predictable and resilient self-pay strategy that allows the health system to remain vigilant in protecting its bottom line against uncompensated care and unnecessary write-offs.
Learn how Coverage Discovery, from Experian Health helps healthcare organizations uncover hidden coverage and maximize revenue.
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