CASE STUDY: Maximizing Revenue
pVerify helps a customer save $3.9 million
Leveraging pVerify tailored insurance verification, eligibility solutions, and support, a healthcare customer with close to 200 locations significantly reduced bad debt, resulting in a client-estimated $3.9 million in saved revenue, and amplified their batch processing capability from 6,300 monthly transactions to 30,000. From batch verification and real-time eligibility to a competitive transaction rate and user-friendly interface, pVerify helped position the client with efficiencies for growth.
Customer Challenges
The senior living and healthcare company has operated thriving senior living communities for over 25 years. In pursuit of their goal to become the one of the best healthcare companies in their operating area, they look for and leverage the best tools for efficiency. Offering outpatient clinics and skilled nursing facility (SNF) services, their insurance eligibility verification needs are complex, so finding those tools is a challenge in and of itself.
Their limited, rotating patient-capacity model required batch processing for Medicare and Medicaid eligibility monthly for current patients and ongoing patient referrals. Staff across all 150+ locations need to easily reference past runs with reporting at a higher level of detail than most eligibility platforms can offer — including their legacy solution. Despite claiming ease of integration, their legacy solution didn’t connect seamlessly with their EHR billing software, leading them to turn to other platforms to supplement and fill those gaps.
Now navigating multiple healthcare portals and protocols, staff bandwidth decreased, and documentation errors became more common, interfering with their commitment to serving patients and their growth potential. In early 2021, they began the search for a more permanent and comprehensive eligibility solution. While they considered many major centralized eligibility providers, pVerify stood out. After two product demos, a clear shared understanding of expected outcomes, and a trial period to test returns, they said,
Other companies wouldn’t consider any enhancements or a test environment.
As we look into other pVerify solutions, we can see where it fits our processes.
We decided to switch to pVerify and do not regret, for one day, that decision.
pVerify Solutions
At pVerify, we work to find specific areas of improvement and opportunity in every partnership. Our Advanced RTE solution identified Medicare Advantage plans that were present but previously didn’t come up in reporting, affecting multiple billing instances. Our customer now receives much more detail beyond what their legacy provider could do, including Part B deductible information, outpatient therapy thresholds met, and days remaining. That — along with pVerify MBI Lookup, Insurance Discovery, and custom API recovery of their monthly batch processing — has significantly reduced time spent on manual entry or troubleshooting and preventing losses through recurring benefit validation, locating commercial or Medicaid payers, and verifying patients with limited information. To support their billing transparency efforts, they also use our cost estimation tool to clearly outline what is covered and what is an out-of-pocket expense for the senior patients they serve.
While our customer has a centralized eligibility team, pVerify provides logins across their network to coordinate all verification activities for 130+ business office managers and 30 billing support team members. More recently, their teams have also begun to use our business rules engine (BRE) to operationalize internal knowledge within the database and auto-populate information on the next steps.
[pVerify] is very streamlined. The Medicare run has the same format as the Medicaid run — it’s easy across the board. We like the user-friendly standardization, including links to the relevant benefits without manual entry or navigation. It’s all right there and accessible.
Outcomes
pVerify solutions significantly improved bad debt, identifying missed prior authorizations and incorrect payer builds to save $3.9 million in revenue (client estimated). Our customer also saw increased batch processing capability, growing from 6,300 monthly transactions to 30,000 seamlessly. When issues arise, they share,
I don’t think I’ve ever had a ticket that has gone over a day before one of [my pVerify team] replied and that it’s been fixed. As soon as they know that a payer is down or comes back online, I get an alert email and that’s the kind of communication that sets them apart.
What’s Ahead
As the company has expanded, we continue to partner in new ways — whether attending internal informational fairs, leading virtual training for new staff, or providing guidance on integrations for other tools and platforms. Most recently, we’ve integrated with their new AI ticketing bot for incoming patient referrals, and we are also testing our SNF history feature to give teams information on a patient’s past hospice care and frequency of verifications.
[pVerify] knows exactly what we need and if we need to modify it, whether we want a payer or specific display, they’re right there to do it. They just grow with us.
