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Healthcare RCM Platform Delivers 10% More Collections for Customer Using Real-time Insurance Discovery

ZOLL Data Systems | Jan 31, 2024

Inovalon, a provider of cloud-based healthcare clinical and economic solutions, wanted to help their collections agency customer (serving radiology groups, urgent care facilities, and hospitals) overcome the limited access to data and insurance carriers that was hindering its ability to recoup payment. With a previous revenue cycle management (RCM) vendor, the customer encountered many issues, including difficulty navigating a complex platform, inability to obtain useful data, and struggling to obtain data in a usable format. The process was inefficient and slow, and combined with data deficiencies, it reduced the customer’s collection rate.

Priority Claims Are Processed More Efficiently With Automated Tool 

A more efficient and proactive solution was needed to improve their customer’s collections. The ZOLL® AR Boost® Insurance Discovery tool built into the revenue cycle management solution suite on the Inovalon ONE® Platform was the perfect solution. Inovalon’s customer immediately took to the user-friendliness of the tool and its better data visualization, which allowed agents to speed up their processes and focus on accounts that had a higher probability of reimbursement. By offering automated insurance discovery, Inovalon better served their collections customer, helping them get claims out the door more efficiently.

Batch Processing Finds More Coverage — and Revenue — Faster

The ZOLL AR Boost Insurance Discovery tool on the Inovalon ONE RCM platform enables the collections customer to automatically find billable coverage for accounts previously presumed to be self-pay. Before, the customer had relied on basic information like name, address, date of birth, etc. However, many of their vendors required a patient identification number, which they did not have, limiting the effectiveness of their collection efforts. The tool solves this problem by identifying primary, secondary, and tertiary coverage.

Using automated insurance discovery, the customer was able to quickly boost efficiency. Thanks to the tool's ability to locate previously hidden, billable coverage in real time, the customer’s agents were able to realize a 10% improvement in their insurance collections. 

To learn more about how Inovalon helped its customer make additional improvements in operational and financial performance, read the case study.

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