Collect IQ

64% of Americans worry about paying their medical bills even when they *have* insurance. ?? ?? High-deductible health plans now cover 31% of U.S. adults under 65, which means more patients are shouldering larger portions of their healthcare costs. This shift puts pressure on revenue cycle teams, who are already dealing with shrinking reimbursement rates. ?? Patients with HDHPs are 58% more likely to delay paying their medical bills due to financial strain. Talk about an accounts receivable challenge. ?? ?? Providers with traditional collections processes are leaving up to 20% of revenue on the table. Translate to millions in lost revenue annually for organizations. What can be done about it? How can we rethink the patient collection approach? An approach that provides an excellent patient financial experience, educates patients about how their health plan works, and provides financial assistance at the right time & place. At Collect IQ, That’s the question we’ve focused all our efforts on answering. #RevenueCycle #HealthcareFinance #MedicalBilling #PatientResponsibility #AR

Why are RCM teams & providers losing in the game against insurance conglomerates? Insurers hold several structural advantages in the American healthcare system that contribute to their dominance in the claim denial process: 1. **Complexity and Bureaucracy**: The insurance industry operates with intricate policies and procedures that are often difficult for healthcare providers to navigate. These include specific documentation requirements, coding guidelines, and pre-authorization rules that vary across different insurers and plans. The right way to submit a claim for 1 insurer isn’t the right way to submit a claim for another. The same is true for appealing a claim. It’s a web of permutations and complexity. 2. **Technological Edge**: Insurers are increasingly leveraging advanced technologies such as artificial intelligence (AI) and machine learning (ML) to analyze claims data and identify patterns that suggest potentially non-compliant or fraudulent claims. This allows them to automate the denial process efficiently and at scale. Healthcare providers, while also adopting similar technologies, often lag behind due to the high cost of implementation and integration into their systems 3. **Regulatory Leverage**: Insurers benefit from a regulatory environment that, while intended to curb healthcare costs and fraud, often places a disproportionate burden on providers. Regulations require meticulous documentation and adherence to specific medical necessity criteria, which insurers can use as leverage to deny claims. Moreover, regulatory oversight on insurers' denial practices is relatively limited, allowing them to push back on claims more aggressively without immediate repercussions. 4. **Resource Asymmetry**: Insurers typically have more substantial financial and administrative resources compared to individual healthcare providers or even larger health systems. They can afford to maintain large teams dedicated to scrutinizing claims and managing denials. On the other hand, healthcare providers must allocate their limited resources across various operational needs, making it harder to match the insurers' focus and expertise in claims processing. 5. **Payment Timing and Cash Flow Control**: Insurers control the timing of payments, which can create cash flow challenges for providers. Delays in payments due to denials or prolonged adjudication processes can significantly impact providers' financial stability. Insurers use this leverage to negotiate lower settlements or delay reimbursements, exacerbating the financial strain on providers 6. **Strategic Denial Practices**: Insurers often deny claims initially as a standard practice, knowing that a certain percentage of providers will not have the resources to appeal. This practice reduces their payout obligations. The appeals process itself is time-consuming and costly, discouraging providers from pursuing every denied claim.