Healthcare News & Insights

3 steps to improved insurance follow-up

Changes in the healthcare industry have put hospital administrators in a tough spot. They must find ways to simultaneously improve productivity and increase cash recoveries. In this guest post, Shawn Yates, director of product management for a company that develops a variety of information systems for providers, will show how insurance follow-up can help with these initiatives.


More efficient and effective insurance follow-up can provide a significant lift to help achieve improvement objectives. To reach those goals, administrators should consider adopting these three disciplines:

1. Automated data retrieval

There are many manual insurance follow-up processes administrators may conduct to retrieve account data. For example, does your staff spend time navigating insurance websites to check the status of a filed claim? Technology exists that can automatically retrieve this information without any human intervention. This is much more than an electronic data interchange (EDI) transaction. In fact, this software produces all the details you need to make pertinent decisions about what to do next with the account via a complete website scrape. That’s just a start. Other technology solutions can enable many additional functions that can help retrieve data on an account. Administrators can dramatically improve productivity by finding functions to eliminate manual intervention with a thorough examination of their insurance follow-up processes.

2. Look for wasted time in daily activities

By analyzing your representatives’ activities, you will find certain functions inherently attached to wasted time. Depending on the function, they can be large or small. For example, how much time is wasted by manually navigating the payer’s interactive voice response (IVR), then waiting on hold to obtain the claim’s status? If you could give your staff a shorter hold time before a representative from the insurance company becomes available, you’d eliminate quite a bit of wasted time. Today, you can save 25% of your reps’ time each month by employing the right technology. This is just one function to examine – look through each step in your representatives’ daily activity to find others. A 25% increase in productivity makes an enormous impact across the business. With a solution to reduce wasted time, administrators can get more out of their inventory by extending their resources.

3. Build work queues with specific tasks to be accomplished

Insurance follow-up processes are often set up for accounts to be reviewed at regular intervals from the bill date. This review is used to determine the claim status and the next action to take. Typically, a rep must then review all past interactions with the account, go to the payer website, and/or call the payer, before waiting on hold 10 to 20 minutes to talk about that account. The rep then determines the necessary action needed to work the account for resolution after this review is completed. It’s an inefficient process, taking too much of your representatives’ valuable time. If administrators follow the disciplines outlined above, they’ll already know the status of their accounts, routing each one into the relevant work queue built to respond to a specific issue.

To truly optimize the insurance follow-up process, the only time a person should manually intervene is if the system can’t accomplish something that must be done. To determine when this intervention might be necessary, internal analytics should be used to show when payers pay your claims and what amount they typically pay.

By automating data retrieval and eliminating wasted activity, hospital administrators can increase productivity in their insurance follow-up process. Workflows shouldn’t be general queues that require a rep to determine next steps; they should be specific to necessary tasks. Use insurance analytics to determine when claims normally pay, and by how much, to flag anomalies on which your team can follow-up.

By automating specific functions in reps’ daily activities and only using manual intervention when necessary, administrators can streamline the overall insurance follow-up process. This will dramatically increase productivity, reduce days in AR and increase cash recoveries, helping administrators achieve improvement objectives in a single swoop.

Shawn Yates serves as director of product management for Ontario Systems, a company that develops a variety of information systems for providers.


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  1. It really depends on the particular policy. Most of the BCBS policies I deal with are hard and fast limitations…your reach that visit limitation, no if, and’s or buts. I’ve had some Aetna policies that would be willing to make an exception for a new diagnosis.

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