Payment Denials and Delays from Inadequate Payer Source Verification

$1,000-$3,000 per claim resubmission cycle (staff time, processing delays, appeals) • $1,500-$4,000 per hospice admission (high-touch verification, appeals for coordination errors) • $1,500-$4,000 per resident per month (Medicaid dependent population, 40-50% of census), secondary coverage misalignment adds 20% appeals workload

Admissions and billing staff manually call payers, log into multiple payer portals, and exchange screenshots and notes via email and paper folders; they track eligibility notes in Excel or on paper instead of an integrated eligibility/PSV workflow. • Admissions checks rough coverage via payer portals or calls, but often relies on hospital case manager assurances and defers detailed checks to billing; notes are free-text in the EHR or on paper. • Admissions collects financial disclosures and application status verbally from families, keeps notes in paper files or simple trackers, and relies on later confirmation from business office staff.