“The current list of underpayments I’m working on will pay for the tool by itself and that’s huge.”
“I created a good patient cost estimates tool on my own using spreadsheets, drop down lists and formulas that showed me the allowables for individual patients. But any kind of break in a formula would be a pain to fix,” said Travis Seymour, Payer Knowledge Analyst at Summit Health.
The solution worked, but couldn’t account for prior procedures outside of their multispecialty practice without phone calls to insurance companies. It was difficult to account for the most finicky of pieces to the patient responsibility puzzle — not to mention it wasn’t scalable for multiple patients at one time.
They needed something that accounted for prior procedures hitting deductible or out-of-pocket maximum, and they needed something that worked at the scale Seymour deals with day-to-day.
The other RCM issue Travis Seymour dealt with was underpaid claims.
“Every practice is being underpaid somewhere, but uncovering where you’re being underpaid can be a huge undertaking,” said Seymour.
Seymour manually audited claims to uncover claim trends and capture large scale underpayments, but since underpayments are difficult to prove it seemed like the work he did couldn't make a dent in large scale underpayment projects.
“I seemed to find potential issues all over the place, but didn’t have the time to investigate every potential place a payer could’ve skimped on payment.”
The right tech solution made all the difference
“After getting Rivet up and running, Rivet has been a really great tool to maintain our contracts, identify and verify underpayments, and notify patients of cost responsibility.
It's nice that everything lives in one place, and I'm not going all over to find what I need or opening all these different spreadsheets. I have one central tool that I can track and monitor payments and move them into work lists depending on their completion status.”
Seymour continued: “With Rivet’s patient cost estimates, the different rules that could break my formula are taken into account. I am confident in the estimates that Rivet creates and it’s nice to have such a robust tool for patients.”
Seymour found that not only could he offer accurate, automated cost estimates for patients using Rivet, he could now hold payers accountable for underpaid claims.
“Underpayments may only account for a small percentage of our overall revenue, but uncovering where a payer is consistently underpaying adds up — and with Rivet we prove underpayment at scale and get the payment our organization deserves,” Seymour said.
"The current list of underpayments I'm working on [in Rivet] will pay for the tool by itself and that's huge. Our return on investment is massive and I expect the return to grow.”
