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Mid-Sized Hospitals Can Increase Revenue Recovery by $500,000 over a Three-Year Period

New TransUnion Healthcare analysis finds Medicaid is a significant source of untapped reimbursements

Identifying insured patients who are also Medicaid eligible can increase hospitals’ revenue recovery from Medicare bad debt by as much as 10% a year. This could mean more than half a million dollars in recovered revenue tied to both Medicare Bad Debt and Medicaid Secondary over a three-year period for the average mid-sized hospital, according to a new TransUnion Healthcare (NYSE: TRU) analysis.

TransUnion Healthcare released the analysis today at the HIMSS19 Global Conference & Exhibition. The analysis included more than 50,000 cost reports over a 10-year period from more than 100 mid-sized hospitals, which represent those institutions with 250 to 350 beds.

The analysis confirms what previous TransUnion Healthcare findings showed, which is between one to five percent of self-pay accounts written off as bad debt actually have billable insurance coverage. This includes already insured patients as well.

“When hospitals limit their insurance discovery strategy to self-pay patients, they are missing an opportunity to maximize reimbursements from other payment sources,” said Dave Wojczynski, president of TransUnion Healthcare. “A complete revenue recovery approach that looks for additional combined coverage for Medicaid, Medicare and commercially insured patients can increase revenue, decrease costs and prevent bad debt.”

According to the Kaiser Family Foundation, 37 states have expanded Medicaid eligibility as of Jan. 4,[1] and it is expected that additional states will expand coverage this year. Although Medicaid enrollment has gained 11 million more members since the Affordable Care Act (ACA) was enacted in 2014,[2] there were still 27.4 million nonelderly individuals in 2017 without coverage.[3] “This presents a clear opportunity for hospitals to obtain revenue from patient accounts that may be dual-eligible for Medicaid and Medicare,” added Wojczynski.

Data from Healthcare Cost Report Information System (HCRIS) also supports this assertion as they found nearly two-thirds (63%) of all Medicare Bad Debt recoveries are tied to dual-eligible Medicare/Medicaid patients. Identifying patients that are eligible for Medicaid increases both Medicaid Secondary and Medicare Bad Debt Recoveries.

“Tracking and recouping earned revenue from previously unknown payment sources, places hospitals in a better financial position to continue to deliver care to their communities,” said Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare. “Hospitals can recover millions in earned revenue with insurance discovery and Medicare reimbursement optimization tools, which not only means a healthier bottom line, but also patients are able to get the care they need.”

TransUnion Healthcare’s Revenue ProtectionSM solutions, including Insurance Discovery, help hospitals prevent revenue leakage. It also ensures earned revenue gets paid while optimizing hospital collection strategies. TransUnion Healthcare works with more than 1,800 hospitals and health systems and has protected over $5.2 billion in net revenue to date for its entire client base.

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About TransUnion Healthcare

TransUnion Healthcare, a wholly owned subsidiary of credit and information management company TransUnion, is a trusted provider of Revenue ProtectionSM solutions that help providers collect more cash up front and throughout the revenue cycle, and identify and maximize reimbursement opportunities to reduce bad debt. By leveraging our data assets, market-leading revenue cycle management technologies, and deep insights into consumer financial behavior, our customers are better enabled to reduce uncompensated care, engage patients early and improve cash flow.

About TransUnion (NYSE: TRU)Information is a powerful thing. At TransUnion, we realize that. We are dedicated to finding innovative ways information can be used to help individuals make better and smarter decisions. We help uncover unique stories, trends and insights behind each data point, using historical information as well as alternative data sources. This allows a variety of markets and businesses to better manage risk and consumers to better manage their credit, personal information and identity. Today, TransUnion has a global presence in more than 30 countries and a leading presence in several international markets across North America, Africa, Latin America and Asia. Through the power of information, TransUnion is working to build stronger economies and families and safer communities worldwide.

We call this Information for GoodSM