RCM Insurance Recovery Insights

We recently checked in with RSi’s Vice President of Revenue Cycle, Stephanie Coggins, to glean insights on best practice in insurance account recovery and denial management. Stephanie tracked several successful decades as a provider-side revenue cycle expert, which has made her a tremendous resource to our clients.

What is the number one overall pain point for providers when it comes to insurance recovery?

I will give the same answer this year that I have in years past: Payer behavior. Experts estimate that health insurance company takeback tactics are costing physicians and hospitals more than $1.6 billion (about $5 per person in the US) a month on average right now. Payer processes change all the time, so we stay up to date on the latest developments to help inform our clients. Payers simply do not communicate policy changes to health systems in a systematic way, and data analytics usage creates even more sophisticated ways to deny a claim. Organizations need a support team that takes a proactive policy approach that considers multiple policy updates to inform the client and foresee changes.   

Every vendor claims expertise in data trends. What’s your pitch for RSi?

Just like any other industry, there are no magic technology unicorns in revenue cycle and, specifically, in Insurance Account Recovery. There also are no perfect processes. Regardless of the level of sophistication deployed with technology, success is always led by talent. For RSi, this means we already have a tenured team from leadership to field level in place, and we can scale up quickly with talented people to meet emerging needs.

Part of the value in having veteran experts on hand is that we can and do identify denial trends and rejection issues so we can resolve and prevent denials. During implementation and throughout the life of our work for a client, we compile sets of inventories and sift through. Our seasoned representatives will often comment during routine reviews, “Oh, I’ve seen this before…,” prompting an opportunity to advise the client and explain what we can do and/or how the client can address. For example, in 2023 we have seen prior authorization denials nearly double. That means extra attention must be paid to prior authorization submissions and appeals.

How can you see a “good client” coming your way?

All of our clients are good clients! Just like the variety of patients seen by a provider, RSi’s clients are not all the same. We follow what we call the CAFE system throughout the operations of the company. CAFE stands for Clarity, Alignment, Focus, and Execution. Clarity involves recognizing that we are not the right fit for every provider and vice versa. We understand that each healthcare provider has unique needs and requirements. We offer flexible solutions, including different contingency rate options based on age at the time of placement, make up of accounts to be placed, timeframe to recover on accounts, and various other components to meet the specific needs of each client. That said, we want to know the client’s most important objectives, and it is critical that the vetting process – on both sides – includes transparency to make a good match. 

What are the most common client driven objectives (CDOs) you receive from your clientele?

• Increase cash: Improve the overall recovery rate and cash flow for the organization
• Speed of recovery: Quick follow-up on unpaid claims reduces the time to payment and prevents them from becoming aged.
• Claim resolution: Thorough and timely follow-up on rejected or denied claims ensures claims are processed and paid appropriately.
• Reduction of aged AR: Special projects focused on resolving aged claims that are outstanding with the payer. 

Final thoughts?

We really do want to be a provider’s “best employee.” Top performing employees typically exceed expectations, can scale to take on more work as needed, and can provide detail, measurable and repeatable KPIs, and unique insights. In fact, RSi truly has the best guarantee in revenue cycle management: If we do not meet your expectations, we do not keep your business. We take all the risks with a 30-day termination agreement. We earn your business every month!

LEARN MORE