ZirMed’s Coverage Detection Solution Identifies Hidden Health Insurance Coverage to Help Providers Collect More Revenue

April 6, 2017

Advanced technology empowers providers to manage the rising self-pay population better, reduce bad debt and increase cash flow

LOUISVILLE, Ky. – April 6, 2017 – ZirMed Inc., a recognized leader in cloud-based revenue cycle software and predictive analytics, today announced the launch of its next generation Coverage Detection solution which includes significant enhancements that improve the overall solution and user experience, expand the healthcare provider markets it serves, and drive even more return on investment for ZirMed clients.

The solution helps providers to manage the ever-increasing population of self-pay patients more effectively—often cited as the largest contributor to bad debt in healthcare. ZirMed’s technology automatically discovers whether patients have health insurance coverage, even if they present as self-pay or are unable to provide insurance information due to acute events, enabling providers to submit billing to payers and get paid faster, more completely and with less effort.

Preliminary results show that ZirMed’s sophisticated business intelligence engine delivers a hit rate of 5 to 15 percent—well above the 1 to 5 percent success rate achieved by manual methods and legacy vendors. That substantially higher percent of discovery translates into millions of dollars in revenue recoupment for providers.

Rising bad debt puts revenue at risk

While bad debt has always been concerning for providers, it has become more urgent with the proliferation of high-deductible health plans, the consumerization of healthcare and the resulting surge in the self-pay population. According to a 2016 Healthcare Financial Management Association survey, hospitals have seen a 10 percent median increase in self-pay dollars over the last five years. 97 percent of hospitals reported an increase in self-pay receivables over the prior year.

These statistics are problematic because it is twice as expensive for providers to collect payment from patients as it is from payers. With this unprecedented rise of self-pay patients, the Center for Medicare and Medicaid Services also predicts unprecedented growth for hospital-based bad debt, with the number ballooning to $200 billion by 2019.

Uncovering coverage to help providers get paid

The Coverage Detection solution is powered by ZirMed’s robust repository of data, which contains billions of healthcare transactions from across the continuum of care, including historical data on health insurance coverage for 1 in 8 patients in America. By leveraging predictive analytics, proprietary algorithms, and advanced payer logic, the solution uncovers actionable insights—highlighting patients who have active coverage and enabling providers to collect the revenue that they are owed more effectively and efficiently.

“ZirMed is committed to understanding not only our customers’ challenges but also the larger industry trends that will impact their revenue in 2017 and beyond. As always, our goal is to help providers get reimbursed for the care that they’re delivering. Getting providers paid is our mission—and we take that mission incredibly serious. Our mission-driven culture is why over 300,000 providers and more than 500 hospitals rely on us every day,” said Ric Sinclair, ZirMed’s Vice President of Product.

To learn more about ZirMed’s Coverage Detection solution, or its other revenue cycle products that get providers paid, please visit www.ZirMed.com.

About ZirMed

ZirMed Inc. empowers healthcare organizations to optimize revenue and population health with a dynamic end-to-end platform of cloud-based financial management solutions—including Claims Management, Charge Integrity, AR Management, Eligibility & Coverage Detection and Value Based Reimbursement. By combining breakthrough predictive analytics technology with innovative development and the industry’s most advanced transactional network, ZirMed’s award-winning solutions extract actionable insights that improve our clients’ revenue cycles and support effective management of population health—while streamlining workflows and increasing operating efficiencies. To learn how ZirMed can help your organization boost its financial and clinical performance, visit www.ZirMed.com.

Media Contact:
Lisa Chernikoff
Amendola Communications for ZirMed

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