The source of many reimbursement issues can be traced back to a simple, avoidable problem: missing or inaccurate patient data. If your revenue cycle team is constantly chasing down missing information, reworking claims, or waiting on payments that never come, you're not alone. Even the most experienced billers and fine-tuned processes cannot compensate for an outdated system. The good news is there’s a better way.

Our latest white paper, “A Multi-pronged Approach to Closing RCM Data Gaps and Capturing More Revenue,” explores how healthcare organizations can take a strategic, technology-driven approach to revenue cycle management (RCM) and optimization of receivables. The article offers insights into the problems that slow down cash flow — and demonstrates how automated tools can help solve them at scale.

The Cost of Incomplete Data

Billing throughout the fragmented continuum of care is complex and fraught with errors. Incomplete demographics. Missing insurance. Patients miscategorized as self-pay patients because coverage was not found. Without reliable patient and payer information, it’s almost impossible for healthcare providers to submit a clean claim, let alone capture maximum reimbursement. This creates revenue gaps, long A/R cycles, and contributes to RCM team burnout.

Tyler Williams, Director of Product Strategy at ZOLL, has lived through these situations. As a former leader at one of the country’s busiest pediatric emergency departments, he and his team spent 20–30 minutes per patient just trying to confirm insurance details — and often came up empty. “It was a cycle of billing, re-billing, and write-offs,” he says.

Necessity is the mother of invention and Williams turned his frustrations into solutions. He developed automated, real-time demographic verification, insurance discovery, and insurance verification tools to solve the problems he and his team experienced. These were commercialized and have since achieved results for customers in emergency medical services, healthcare profitability service providers, healthcare laboratories, and more.

In our white paper, you’ll read more about these innovations and how they close big gaps in billing processes.

A Scalable Solution for Modern RCM Challenges

Instead of letting missing information stall reimbursement, billing teams can leverage industry-leading solutions to plug data gaps before they become payment problems.

Automated RCM optimization tools including demographic verification, insurance discovery, and insurance verification can integrate into your healthcare tech stack and existing workflows to get billers the data they need fast, accurately, and without manual chaos. Having near-instant access to complete, accurate core data drastically improves workflow efficiency and reduces staff stress, boosting revenue from both direct and indirect channels.

As the white paper illustrates, the solutions have helped providers:

• Correct or replace core demographic data for 82% of patient claims
• Discover active, billable coverage for over 40% of cases labeled “self-pay”
• Potentially add $50K in revenue for every 1,000 self-pay claims processed with verification¹

The real-world ROI from customers echoes these numbers. RCM teams and their partners have achieved consistently impressive results by deploying automated, real-time technology to optimize reimbursement, reduce administrative burden, and improve the patient financial experience — using the staff resources already in place.

The white paper provides compelling, persuasive evidence based on these users' experiences and the results they achieved, including one medical billing company that used ZOLL® AR Boost® RCM optimization tools to find, fix, and verify information for the records it submitted, resulting in the recovery of hundreds of thousands of dollars in revenue.

Rethinking What’s Possible

The financial and operational pressures on healthcare organizations are not going away. But with the right tools in place, providers can take control of their RCM processes, capture more revenue for services they provide, and create a more efficient, patient-friendly billing environment.

To learn more about how ZOLL AR Boost automated RCM optimization tools are reshaping healthcare billing, download the white paper.

¹Based on an average claim of $250. Ranges can go from as low as $50 up to $2,500 or higher, depending on the procedure.