COVID-19 is changing the health insurance landscape – how can providers stay ahead?

For many of the 36 million
Americans
who have registered for
unemployment benefits during the coronavirus outbreak, losing their job means losing
their health insurance. Options for the newly-unemployed are limited yet
complicated: while the federal
government
has declined to reopen
enrollment under the Affordable Care Act, several states are supporting those
without coverage by opening emergency
enrollment periods

for state-based health exchanges. Those that can afford it may extend their existing
employer plan through COBRA, while those that can’t may apply for Medicaid. But
unfortunately, millions will be left without coverage.

Now, with these changes
happening in both large quantities and at rapid speed, the process for checking
a patient’s coverage status is more complex, time-consuming and susceptible to
errors than in normal circumstances. Further errors may appear as patients are
forced to switch care teams, leading to disjointed care and incomplete,
inaccurate or duplicate health records.

It’s a huge administrative
and financial burden for providers, who must keep pace with changes to the
health insurance landscape or risk a surge in denied claims as a result of
patient misidentification. How should they guard against patient identity errors
and minimize revenue loss in the wake of COVID-19?

How
to prevent mismatched patient records and avoidable claims denials

A 2018 survey found a third of denied healthcare claims were caused by patient identity errors, costing hospitals an average of $1.5 million. We may see this figure creep up following COVID-19, unless providers move quickly to implement robust identity proofing and patient matching processes. Providers looking to do this should consider prioritizing the following three areas:

  • Eliminate errors during patient registration

Up to half of denied claims occur earlier in the revenue cycle, which is also when most duplicate medical records are created. Improving identity proofing during patient scheduling and registration is a logical place to focus, to ensure records are accurate from the start.

This should include proactively checking for active coverage as early as possible. Using a Coverage Discovery tool that automatically finds available coverage will help avoid bad debt write-offs and give patients peace of mind. Essentia Health’s Patient Access team were able to find 67% coverage pre-service, for patient accounts that were previously considered self-pay or uninsured.

  • Automate identity matching throughout the revenue cycle

When patient records are incomplete, duplicated or overlaid with part of
someone else’s record, denied claims become an accepted cost – but they’re
often avoidable.

Instead of time-consuming and error-prone manual checks, providers should consider using automated identity management software to ensure patient records are accurate and complete. Data-driven matching technology supported by a Universal Patient Identifier allows a single view of each patient to be shared safely and securely across multiple healthcare services. There’s no need for tedious reconciliation work and providers can be confident they’re submitting clean claims each time.

  • Improve identity management protocols for telehealth and mobile services

More patients turning to telehealth services and patient portals to
minimize face-to-face contact, putting pressure on providers to solve the
patient matching problem. And with payers expanding coding for reimbursements
for telehealth and remote services, there’s an added imperative to make sure
patient information is accurate in order to minimize the risk of claims
denials.

Victoria Dames, Senior Product Director at Experian
Health, says portal access has increased by roughly 40% since the start of the
coronavirus outbreak, and explains that the rise in telehealth and mobile
services means identity proofing must be a priority:

“If you don’t already have identity proofing and automated solutions for
patient matching in place, you’ll have duplicate records. We don’t want that –
it’s important to have one view of the patient. But we need to move quickly.
Automating for identity proofing eliminates the risk of human error and it’s
faster too, which is crucial right now. We know many providers want to get
their identity management and claims management systems optimized quickly, so
we have a team set up to help.”

Using
the right technology to verify patient identities and analyze claims, avoidable
denials resulting from missing or incorrect information can be caught sooner.

Contact
us
to find out how we can help
your organization manage patient identities to eliminate costly claims denials
during and after COVID-19.