Dodging Revenue Leaks

Fixing the Gap Created by Healthcare Reform


The evolving landscape of healthcare reform continues to pose reimbursement challenges for hospital systems. Providing long-term patient care and delivering clinical services to the uninsured, self-pay and Medicaid patients may impact the bottom line.

Millions of dollars are being lost as a result of mismanaged claims and underpayments. Unless hospitals can find a way to fix the gap, their financial viability is at risk.

An estimated $7 billion could be saved if insurers paid claims correctly.1

As of 2013, the error rate on paid medical claims for commercial insurance companies averaged 7.1 percent.2

The Federal Marketplace, State Exchanges and Medicaid rules are difficult to understand.

Hospital personnel are challenged with verifying insurance, filling out pre-authorization and admissions forms as well as filing claims.

Too often co-payments are delayed causing excessive resources for follow-up and the likelihood of payment decreases with time.

Higher insurance premiums and dips in the economy are just two of the reasons hospitals are finding more uninsured patients.

Unaware of the resources available to offset their medical costs, many patients walk away dissatisfied and burdened by medical bills.

To survive the era of healthcare reform, hospitals need to invest in revenue cycle management and a technology system that can successfully track claims and manage revenue leaks.

The Revenue Cycle Management (RCM) market is expected to grow at a compounded annual rate of 7.2 percent from 2014 to 2019.3

Transparency and Technology: Strategies That Protect Your Bottom Line

At HCFS, our revenue recovery system checks state and federal programs as well as commercial carriers, driving revenue optimization and bringing transparency from cost-to-charge.

HCFS has software specifically designed by our experts to ensure accuracy in assessing patient eligibility, determining third-party payers and forecasting revenue.

Working with the hospital, HCFS can help uninsured patients who may not know if they qualify for benefits, apply for Medicaid and other Federal and State programs to help cover medical expenses.

HCFS patient account representatives (PARs) are Certified Enrollment Counselors (CEC)/Certified Application Counselors (CAC).

When patients arrive, PARs gather all of their insurance information to determine whether they are self-pay, uninsured, or need Marketplace assistance and will even initiate the patient’s Marketplace application on their behalf.

Although the challenge you face may be immediate, our team is looking to your future. It’s not just about filling a vacant position for a short period of time; it’s about seamless support from start to finish.

Our technology, combined with a one-on-one patient approach, and personal relationships with the various state and county offices ensures success on each patient account.

Ensure Revenue Integrity

At HCFS, we won’t let any opportunity to recover revenue slip through our fingers, whether it’s from lack of internal procedures or an existing plan.

We’ll help you keep track of your payer contracts.

Contact us today to learn how our patient eligibility services and advanced technology systems can fix revenue leaks and ensure your financial viability.


2. AMA
3. MicroMarket Monitor: