For years, healthcare providers have witnessed explosive growth in the number of patients who are self-pay or on high-deductible health plans (HDHP). Even for those who have commercial insurance, the patient share of healthcare financial responsibility is increasing. Since 2012, the average annual deductible for workers who are enrolled in healthcare insurance through their employer has blown up by 61%.ⁱ

Self-pay and HDHP patients take longer to pay and pose a higher risk of write-off. This adds to the already significant financial strain on medical practice, emergency medicine, and specialist providers. Therefore, it is in providers’ best interest to search for healthcare insurance coverage as early in the patient encounter as possible to prevent the claim from becoming classified as self-pay in the first place.

One of the most effective solutions for combatting the lack of reliable patient demographic and insurance information is an automated revenue cycle management (RCM) optimization tool suite that can find, correct, and verify patient and payer information. Providers who put AI-enhanced, real-time technology to work can improve their clean claims rate and pull payer dollars in more quickly. Automated RCM optimization tools can be integrated into existing workflows and systems as early as patient scheduling and registration, or later during billing and patient engagement.

ⁱKFF Employer Health Benefit Survey Finds, https://www.kff.org/private-insurance/press-release/annual-family-premiums-for-employer-coverage-average-22463-this-year/, KFF health Affairs, accessed 7/9/24.