(Would $390,000,000 be out of the question?)
For the past several years Databound has been working with a large hospital consortium in Alaska to help them identify private insurance coverage for their patients. We’ve learned that a high number of Alaska Natives seek care and do not provide information to the Hospital regarding their insurance coverage, rather they report Indian Health Services as their primary payer.
Turns out that many times a patient qualifies for insurance coverage through an employer or through government programs, and these numbers will increase with the Affordable Care Act and Medicaid expansion. For hospitals, searching out and finding this type of coverage is time consuming, so the payments are often forfeited because of limited resources to find these additional eligible payers. This is where Databound can help.
Our fully-managed reCover service searches a list of hospital patient encounters with an outstanding balance and finds new or previously unknown eligibility information from private payers. At one hospital in the consortium around 8% of the time the patient has insurance that ends up in a payment.
8%? That may not seem like much. But it is.
In 2014 with one hospital alone we found patients with unreported active coverage had more than 12,000 encounters. Because payments averaged around $1,000 per encounter, the hospital recovered nearly $13,000,000.
What would it take to get that kind of appropriation for a single hospital?
So, let’s do some bigger math using representative results from our existing customers:
According to the Indian Health Service in 2014 there were just over 13,000,000 patient visits funded through the program.
Applying a success rate of just 3% in finding active coverage that results in a payment, and an average payment of $1,000, the impact to IHS funded programs could be as much as $390 million per year.