Slow Payer Verification Delays Cash Collections
Definition
Delayed eligibility and payer source verification during admission extends Accounts Receivable days and slows cash inflow. Facilities must contact insurers manually, causing bottlenecks before billing can proceed. This drag is recurring across admissions in SNFs and nursing homes.
Key Findings
- Financial Impact: $Unknown - leads to high AR days without specific $ figures
- Frequency: Per resident admission
- Root Cause: Manual processes for collecting patient data, contacting payers, and confirming coverage details without automation.
Why This Matters
This pain point represents a significant opportunity for B2B solutions targeting Nursing Homes and Residential Care Facilities.
Affected Stakeholders
Eligibility verifiers, Billers, CFOs
Deep Analysis (Premium)
Financial Impact
$1,000-$3,000 monthly (low volume; MDS follow-up time) • $10,000-$25,000 monthly (5-10% of admissions require independent re-verification; each re-verification delays intake 1-3 hours) • $10,000-$25,000 monthly (5-10% of admissions require re-verification due to discharge planner data gaps; each re-verification costs staff time + potential denial)
Current Workarounds
Admissions director calls MCO; transcribes plan details; maintains spreadsheet of MCO verification status; some calls fail or require multiple attempts • Admissions director calls state Medicaid office; handwritten notes on admission form; maintains spreadsheet of pending Medicaid verifications; some facilities use WhatsApp to flag issues • Admissions director expedites manual verification; calls payer directly; sometimes completes intake before verification is confirmed; admission notes flagged as pending verification
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Methodology & Sources
Data collected via OSINT from regulatory filings, industry audits, and verified case studies.
Related Business Risks
Payment Denials and Delays from Inadequate Payer Source Verification
Accreditation and Regulatory Failures from PSV Non-Compliance
Underreporting Functional Scores and Nursing Components
Costs of Directed Remedies and State Monitoring for Deficiencies
Decision Errors in Informal Dispute Resolution (IDR) Appeals
Fines and Payment Denials from Uncorrected Survey Deficiencies
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