An Advisory Board in one of its recent surveys reported that a median hospital lost $3.5 million in uncollectible claims. There has been a sharp increase in the number of claims that providers have been writing-off lately. 

Statistics indicate that in 2017 there were reportedly 90 percent more cases written-off than in 2011. Most of them due to eligibility related issues.

There is an urgent need for providers and payers to sit down together to resolve impending issues. Many questions need to be clarified and understood by claimants.  

Does a procedure require prior authorization? Is a claim approved or denied? What is a patient’s eligibility for services? These questions directly affect the revenue stream of providers, and they should be looking for answers.

St. Francis Hospital in Columbus, Georgia, was buried in the day-to-day manual processes of dealing with payers.  They decided to upgrade to web-bot technology to deal with payers, and things gradually started looking up. 

Before the web-bots, St. Francis’ annual point-of-service collections were close to $1 million in 2012. That figure doubled in 2013, with web-bots in place. It grew to $3 million in 2014, $4.2 million in 2015 and $4.9 million last year.

Recondo Technology that setup the web-bots replaced the manual task of querying payers on a host of claim issues that the hospital usually have. 

Earlier, it took them a while to receive a response from the payers. With automation, the providers receive an instant response.

Assuming, if the front desk at St. Francis Hospital, for instance, wants to find out from a payer, the eligibility criteria of a patient or his financial responsibility, the web-bot will log into the appropriate payer’s website using St. Francis’s login credentials, and instantly pull out the patient’s contract in readable format, to determine his eligibility criteria with coverage details. 

Or, for instance, if St. Francis needs an estimate of a patient’s cost for services, the web-bot compares the patient’s eligibility for services, as reflected in the payer contract, with St. Francis’ chargemaster, and then it creates the estimate.

No longer do they have to slog through all the daily stacks; the web-bot solution does much of this interaction with payers instead, at a fraction of the time it used to take manually. So they haven’t had to increase their staff or contract with a third party, one of which they would have had to do at some point without web-bots.