Navigating the Quickest Route to Payer Reimbursement and Patient Payments

Like never before, providers need help navigating from Point A: delivering billions of dollars’ worth of services, to Point B: receiving reimbursement for services rendered. The current path is filled with roadblocks, detours, and seemingly endless delays.

Every year, about nine percent of medical claims are initially denied. Healthcare.gov marketplace denials are more than double that, with an average of 19% of claims getting denied. For the average hospital, this puts $5 million in annual revenue at risk. And that’s just on the payer side. When you consider the uncollected payments from patients who are now responsible for 12% of their medical expenses, the need to recalculate the route becomes even greater.

The process of getting paid starts before a claim is submitted or a patient is billed. Healthcare CFOs and executive leadership are at a crossroads. Either continue down a path fraught with delayed reimbursements, expensive appeals, and patient write-offs, or take an entirely different route – one that is more strategic and will actually get you paid. As you’ll see in this book, that route begins even before the patient receives service.

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