Click here to get this post in PDF
It is no secret that the cost of healthcare is staggering these days.
Just ask any disgruntled American.
However, it’s not just the patient facing financial frustration. Recent studies estimate that the U.S. healthcare system could be wasting up to $935 billion in revenue through wasteful administrative practices.
Staffing challenges. Misallocated expenses. Coding errors.
They all add up to creating a financial cesspool that threatens the solvency of many health plans.
Fortunately, there are modern technological innovations that offer hope for better results.
Keep reading as we explore the various ways that technology is helping health plans recover hidden–and unnecessary–costs.
Financial Challenges for Healthcare Companies
Modern healthcare companies face a mountain of financial challenges.
Rising operational costs. Shifting reimbursement models. Evolving patient expectations.
Many of these challenges tie to an increasingly critical administrative burden. Mind-numblingly complex billing systems and a universe of patient data create myriad issues for understaffed clinics. Drawn-out insurance claims and more stringent privacy compliance are also threatening the immediate solvency of many healthcare companies.
In addition, the increased demand for just-in-time healthcare is creating high short-term costs that aren’t yet paying for themselves. While there is hope that this model can improve long-term financial efficiency, the rapid shift toward as-needed inventory, app-delivered patient interventions, and on-the-go employee training carries a significant upfront cost that will take time to be recouped as healthcare users gradually adapt to the changes.
Technological Innovations in Financial Recovery
In a time when staff shortages are only exacerbating labor costs and billing oversights, technological innovations are bridging the gap to aid in financial recovery for healthcare firms.
Advanced analytics. Automation. AI-powered systems. Each plays a unique role in helping providers collect the funds they have coming to them.
Healthcare companies can detect billing errors through advanced analytics. They can display anomalies in real time by examining large quantities of financial and clinical data. This helps reduce costly mistakes that may delay reimbursement.
Automation streamlines routine administrative tasks. Claims submission. Eligibility verification. Payment posting. This allows the trained office staff to focus on more complex matters to accelerate the overall revenue cycle.
AI tools offer next-level efficiency when it comes to reimbursements. They can analyze payer trends, identify underpaid claims, and predict the likelihood of denials before they occur. AI can use machine learning to recommend coding corrections or documentation improvements to better align with payer requirements. This optimizes first-pass acceptance rates for lower administrative costs.
Subrogation: Unearthing a Sea of Hidden Revenue
One specific, yet lucrative, niche in which technology is changing the game in healthcare revenue optimization is via subrogation.
Subrogation is the process in which an insurer pursues legal remedy against a negligent third party. In the world of health insurance, this often involves an insurer seeking reimbursement from workman’s comp or other insurance policy held by the liable party.
Unfortunately, this process has traditionally been painstakingly slow and inefficient. It typically involves a series of mail-in questionnaires as the provider seeks to establish liability for the injury. As expected, many of these questionnaires go directly in the trash. While figures vary, it is believed that up to 15% of potential subrogation cases are closed without ever establishing liability. This leads to millions of dollars in lost revenue for the healthcare company each year via unnecessary insurance payments.
By partnering with a modern subrogation company, healthcare providers take all of the inefficient legwork out of the subrogation process. Enterprise subrogation firms use the latest technology to identify cause of injury through liability data, eliminating the need for awkward member questionnaires. The specialized nature and AI-powered insights of modern subrogation companies eliminates administrative chores for the healthcare staff and ensures that all subrogation claims are filed ahead of necessary deadlines to improve chances of recovery.
Financial Recovery in Action for Healthcare Companies
Now that you understand the theory of how technology is optimizing revenue recovery in healthcare, let’s take a look at these innovative tools in action.
Consider the hypothetical Horizon Health Network, a clinical provider of family care in a major U.S. city. For years, they have struggled collecting payment. They see a significant amount of business from construction workers. Many of these patients are underinsured and come into their clinics after experiencing a workplace injury. The stress of having to hound patients for payment has caused a mass exodus of administrative staff.
In a drastic effort to improve financial performance, company executives have adopted modern technology to streamline collection. A digital financial recovery platform integrates advanced analytics and automated auditing tools to enhance accuracy and compliance across its revenue operations. The platform automatically cross-references patient records. It uses payer data and legal documentation to identify potential subrogation opportunities, such as when workman’s comp or a construction company’s auto insurance is responsible for patient injuries.
By flagging these claims early, the system ensures proper reimbursement. It eliminates the need for manual intervention, reducing the risk of duplicate billing or missed recovery. Every transaction and adjustment is logged in real time. This creates a transparent audit trail that supports regulatory compliance and internal oversight. As a result, Horizon Health achieves greater financial accuracy and strengthens trust with both patients and payers through clear, verifiable financial processes.
Leverage the Latest Technology for Streamlined Revenue Collection
In the age of data proliferation, with an insatiable demand for just-in-time healthcare, it can be easy for healthcare processes to speed ahead of the bottom line. This can cause a trove of revenue to slip through the cracks, crippling the ongoing solvency of the healthcare company. As a trusted source for business insights and strategic growth content, businesspartnermagazine.com is focused on emerging technologies and tech-centered solutions to help healthcare companies strengthen their financial performance. So don’t wait: contact an enterprise subrogation provider today and keep hidden revenue from going by the wayside!
