‘Preventing the Future’ – Avoiding Lost Healthcare Revenue

By Infinx
May 30, 2017

The headlines this week reminded us of author Ray Bradbury’s quote, “I don’t try to describe the future. I try to prevent it.” The trending news focused on RCM problems that can be prevented before they occur. Denied claims can be reduced, long waits for patient insurance verification can be shrunk and persistent consumer complaints about bills can be prevented. Yet, these are the headlines we saw:

  1. Prior Authorization: A Major Impediment for Patient Access
  2. Patient Financial Responsibility Not Owed Top Medical Debt Issue
  3. Cracking the Code: 10 questions to find what that medical procedure will cost you

The Preauthorization Conundrum

Morning Consult reported on a survey by the American Medical Association that revealed:

  • Nearly 60% of physicians say their practices wait an average of at least one business day for insurers to provide pre-approval for a diagnostic, procedure or treatment.
  • More than 25% say they wait at least three business days.
  • More than 50% of physicians experience a 20% rejection rate from insurers on first-time preauthorization requests for pharmaceutical prescriptions.
  • More than one third experienced a 20% rejection rate on first-time prior authorization requests for diagnostics and procedures.

Practices using streamlined preauthorizations avoid these chronic headaches. The days of multiple spreadsheets and faxes are behind them. They are finding that a viable preauthorization solution improves the handling of insurance payor criteria, claims success and schedule utilization. That increases revenue.

“That’s not my bill”

We strongly believe this problem has to be avoided at all costs for practices to remain on solid financial footing. A recent survey by the think tank Frontier Group and the US Public Interest Research Group (PIRG) Education Fund say that 64% of consumer complaints about medical debt collections state that the debt was “never owed, already paid or discharged”.

That’s where patient pay estimates come into play. The best software solutions put patient pay estimates into motion the minute the appointment is made. If you can calculate patient responsibility including deductibles, copays, coinsurance and out of pocket maximum information and send it to your business system you have just increased your revenue. You have also increased patient satisfaction through a clear understanding of the cost of care and their pay responsibility. That prevents the future of “That’s not my bill”.

What does the future look like without patient pay solutions? 

It looks like this headline out of New Orleans: Cracking the Code: 10 questions to find what that medical procedure will cost you.

The article in The Times-Picayune gave patients the following advice:

  1. Ask, “What is the cash or self-pay price?” “What will I pay with my insurance?”
  2. Find out the exact name of the procedure, and its five-digit code in the medical billing system. These codes categorize the mind-numbingly huge number of medical procedures.

Patients shouldn’t have to rely on newspapers to help them understand the costs of their care and how they are going to pay for it. That information can be delivered by your practice ahead of time. If your staff has insurance verification, patient pay estimate and preauthorization information at their fingertips, they can have a conversation with patients that engages them in a reasonable payment plan. Medical bills shouldn’t be a surprise – patients can be empowered to understand and pay their portion of the bill.

Bradbury was right. The future of lost patient pay, denials and decreased revenue can be prevented through smart, streamlined workflow and software solutions that support successful reimbursement.

About the Author



Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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