Sunbelt White Paper InternationalClaimsComplexities DIGITAL

Optimizing Revenue from International Claims: Navigating Complexities and Maximizing Returns JULY 2025 Introduction Financial Impact of Mismanaged International Claims Key Challenges of International Claims Management Essential Best Practices to Maximize International Claims Revenue Leveraging Technology and Legal Expertise Real World Success: Case Study Insights Key Metrics About Sunbelt Health Partners 3 4 5 5 6 8 9 11 TABLE OF CONTENTS Conclusion 10 3 | international.sunbelthealthpartners.com Though international patient claims typically represent a modest portion of overall revenues, their complexity and high denial rates necessitate specialized attention. International receivables demand expertise beyond standard domestic claims management, given the diverse payer systems, global regulatory considerations, challenging legal framework, and unique contracting complexities. Sunbelt Health Partners, established in 1980 and specializing in international claims since 1994, brings deep payer relationships and decades of experience addressing these specific challenges. This whitepaper distills key insights from recent market research, case studies, and expert discussions, offering actionable strategies healthcare providers can employ immediately. A report by Becker’s Hospital Review highlights the fluctuating operating margins for health systems over the past year, ranging from -1.2% to as high as 5.5%. These variations demonstrate how even small percentages of revenue can make a substantial difference, especially in a climate where increased patient volumes are offset by high labor and supply costs (Madeline Ashley and Alan Condon, Becker’s, April 10, 2024). This whitepaper provides an in-depth look at challenges and best practices for managing international receivables, demonstrating how specialized revenue cycle management (RCM) solutions can markedly improve financial outcomes, streamline processes, and enhance patient experiences. Introduction International claims may represent less than 2% of total revenue for most health systems, but it’s crucial for revenue cycle management (RCM) executives to prioritize this area. international.sunbelthealthpartners.com | 4 These issues are common across all payers, but their root causes can vary. Proper metrics and benchmarks allow for quick identification of performance issues. Poor management and communication, missing steps, and failure to measure key metrics result in untimely revenue loss and cash flow problems. It’s essential to measure and benchmark international claims metrics differently from other revenue cycle areas to avoid having billing issues go unnoticed. Common financial issues arise due to: • • High denial rates stem from inadequate verification of eligibility and authorization at the outset Research from the U.S. Cooperative for International Patient Programs (USCIPP), a consortium of American academic medical centers and health systems that offer services to international patients, providers, and other partners, indicates over half of healthcare providers report a negative revenue impact when domestic insurance rates are erroneously applied to international claims, with one-third stating this occurs on more than 75% of claims. For major health systems, such inaccuracies can result in multimillion-dollar losses annually. Financial Impact of Mismanaged International Claims Patient misclassification as domestic instead of international often results in incorrect billing rates • Poor communication with international payers causes reimbursement delays or write-offs 5 | www.international.sunbelthealthpartners.com Key Challenges In International Claims Management Providers face multiple barriers efficiently managing international claims, notably: Manual and Inefficient Processes: Lack of automated processes and reliance on paper- based systems lead to delayed payments and operational inefficiencies. Complex Contracting Dynamics: International payer contracts are highly nuanced, often requiring legal interpretation and aggressive enforcement to ensure compliance. Poor Front-End Management: Errors at patient registration and inadequate authorization processes significantly increase claim denials and administrative rework. Limited Technology Integration: Suboptimal EDI connections and fragmented workflows impede claim tracking and timely reimbursements. Essential Best Practices to Maximize Claims Revenue Based on a recent Sunbelt webinar and market insights, several key practices emerged as essential: Unified Internal Strategy: Establish leadership-driven strategies for international claims to ensure organizational alignment and clear accountability. Proactive Eligibility and Authorization Verification: Implement robust, front-end processes to reduce denial rates, significantly enhancing cash flow. Enhanced Cross-Departmental Integration: Regular communication and training among international patient services, finance, and managed care improve overall accuracy and reduce internal barriers. Comprehensive Contract Governance: Employ dedicated legal expertise to enforce international payer agreements aggressively, reducing underpayments and accelerating cash collections. www.international.sunbelthealthpartners.com| 6 Sunbelt leverages specialized tools and legal resources designed explicitly for international claims management, including: Leveraging Technology and Legal Expertise Global Claims Processing Infrastructure: State-of-the-art dialer technology to contact international patients effectively, significantly boosting outreach success. Advanced Performance Analytics: Proprietary databases that tracks performance and identifies claim trends, ensuring proactive issue resolution and continuous improvement. In-House Legal Team: Experienced attorneys provide real-time legal consultation, directly negotiate with international payers, and enforce contract compliance to expedite payment. Multilingual, U.S.-Based Support: Robust language support (60+ languages) ensures clear communication and streamlined patient interactions, greatly enhancing patient satisfaction and compliance. A prominent multi-state health system recently partnered with Sunbelt to optimize its international claims management. Key outcomes included: 34% increase in collections at border state regional medical centers 25% improvement at northeastern community hospitals Significant improvements in administrative efficiency and patient satisfaction This case illustrates how specialized international claims expertise directly enhances financial outcomes and patient experience, creating measurable, sustainable value. Real-World Success: Case Study Insights 7 | international.sunbelthealthpartners.com Choosing the right international claims RCM partner requires careful evaluation of several key performance indicators (KPIs): Vendor Trust and Accountability: Proven track record and strong client references. Innovative Technology and Intelligent Automation: Robust, scalable systems designed specifically for complex international claims. Legal and Compliance Expertise: Dedicated legal team adept at handling payer disputes and regulatory complexities. Consistent Performance Metrics: Benchmarked data demonstrating tangible results in AR reduction, increased collection rates, and accelerated cash flow. Providers must critically evaluate potential partners against these KPIs to identify the most effective solution aligned with organizational needs and strategic objectives. Choosing the Right Specialty RCM Partner Key metrics to track for international claims include: Tracking these specific metrics allows healthcare providers to benchmark their performance and identify areas where process improvement needs to be made rapidly. INVENTORY AGING NET COLLECTION RATE: DAYS TO COLLECT (FROM DATE OF SERVICE: TAILORED PER CLIENT www.international.sunbelthealthpartners.com|9 SELF-PAY: 25-30% THIRD-PARTY: 60-80% SELF-PAY: ~120-150 days THIRD-PARTY: ~90-120 days ABOUT SUNBELT HEALTH PARTNERS Sunbelt Health Partners, a Unified Health Services (UHS) company, is a leader in international claims recovery and receivables management. With over 30 years of specialized experience and managing over $1 billion in international receivables across 100+ countries, Sunbelt provides tailored, technology-driven solutions. Our dedicated legal and multilingual teams ensure timely reimbursements and improved financial outcomes for healthcare providers worldwide. Healthcare providers face significant risks and opportunities in managing international patient claims. Specialized international claims management practices—rooted in proactive processes, advanced technology, and legal expertise—are essential for reducing denials, accelerating payments, and maximizing revenue from this complex financial class. Sunbelt Health Partners offers providers a proven model for international claims success, delivering consistent results through expert management and comprehensive, integrated solutions Conclusion For more insights and detailed strategies, visit our blog at www.international.sunbelthealthpartners.com/blogs/. [email protected] 1-954-568-1033 www.international.sunbelthealthpartners.com