There’s a number that tends to stop CFOs in their tracks: how much of your self-pay bucket isn’t actually self-pay at all?
That was the question at the center of a recent Eleos webinar, Plugging the Leak: How Crosswinds Recovered Hidden Revenue Through Eligibility Intelligence, hosted by the National Council for Mental Wellbeing. Sarah Stockwell, CFO of Crosswinds Counseling and Wellness in Emporia, Kansas, joined Eleos’ Taylor Gleason to walk through how her organization uncovered hundreds of thousands of dollars in coverage that was sitting unbilled, right under their noses. Watch the full webinar here.
The Problem: You Don’t Know What You Don’t Know
Crosswinds serves a seven-county area surrounding Emporia and is one of 25 Certified Community Behavioral Health Clinics in Kansas. Sarah joined as CFO in 2022 after 23 years in public accounting, and one of the first things she noticed was a growing bucket of unpaid self-pay balances.
Crosswinds provides services regardless of a client’s ability to pay, so some self-pay volume is expected. But as Sarah dug in, she found something else entirely: clients who had insurance coverage the whole time, coverage the organization simply didn’t know about until it was too late.
“I wanted to know what we didn’t know,” Sarah said. That question was the starting point for the eligibility intelligence solution Crosswinds would go on to build with Eleos.
The old process was almost entirely manual and reactive. When a denial came in for eligibility, staff would log into payer portals to check if the denial was accurate. If there was a coordination of benefits issue, they’d try to track it down with the client or provider directly. In the worst case, a large self-pay statement would go out in the mail, and only then would a client call in, surprised, saying they had insurance the whole time.
“It was just a black hole of everything,” Sarah said, describing the maze of payer portals her team had to navigate. Different plans required different portals. Passwords changed. Systems occasionally were swapped out entirely. And multiply that across commercial payers, Medicare, Medicare Advantage, and Kansas’ three main Medicaid MCOs, and the manual burden is enormous.
Crosswinds’ experience exemplifies a pattern playing out across the industry.
A live poll during the webinar backed this up: 40% of attendees said eligibility changes or coverage gaps caught too late were among their biggest sources of lost revenue, closely followed by claims denied after submission.
Why This Is A Patient Care Problem
The financial impact was real. In the nonprofit world, as Sarah put it, “$20 is $20,” and every missed claim adds up. But the deeper motivation wasn’t purely financial.
Clients were opening bills for services they thought were covered, and by the time anyone realized otherwise, the organization had often already missed the timely filing window to bill the correct payer. That created confusion and frustration for clients who were already coming in for mental health support, and it created friction for the billing staff on the receiving end of those upset calls.
“I wanted to reduce that impact on them, as well as for my back-end staff,” Sarah said.
Building the Solution Together
“I don’t do the actual work every day,” Sarah said. “So talking to my team and really hearing what their pain points are and seeing what the manual process was, that was kind of the first step.”
Sarah took an idea and the feedback from her team to Eleos, an established partner for documentation and compliance.
From there, the Eleos team worked with Crosswinds to test data and shape a solution designed specifically around the gap: not just verifying that a known policy was still active, but proactively surfacing coverage the organization didn’t know existed.
Staff were initially hesitant. Crosswinds had already rolled out a new EHR alongside an AI solution and a tool for addressing claims denials around the same time, so another new system raised some eyebrows. But once the team understood the goal, less manual chasing and not more work, buy-in came quickly.
“Now it’s just been, ‘oh, great, oh, you mean that AI can work for us as well?’” Sarah said. “It has not completely eliminated, and will never eliminate, a position, but it allows that position to focus on things that matter.”
The Results
Once the eligibility intelligence tool was in place, the impact showed up quickly and in more than one way.
Crosswinds’ three Kansas MCOs frequently see clients move between them, and previously, those changes often went undetected until a claim was denied. Now, the organization catches those shifts proactively, no client outreach required, and gets claims out the door without delay.
The same held true during Medicare Advantage plan changes at the start of the year. Where in past years Crosswinds might have experienced a revenue “drop” as plans shifted, this year they were able to identify the correct plan quickly enough to avoid billing clients incorrectly.
On the numbers side, Taylor shared that Eleos’ upfront ROI analysis process, which samples a set of an organization’s patient data to estimate potential recovered revenue, showed an 8x initial ROI for Crosswinds, and identified roughly $180,000 in annual revenue the organization was able to recover or prevent from being lost.
Just as important to Sarah: the reduction in client-facing friction. Billing staff spend less time fielding frustrated calls about unexpected bills, and clients experience fewer surprises during an already difficult time in their lives.
“We’re not having as much frustration from the clients with the billing department,” Sarah said. “The messenger is the devil, so they really have a goal of working with the clients, and we don’t want to place any additional burden on them.”
Looking Ahead: HR1 and the Shrinking Grace Period
Much of the conversation also turned toward what’s coming. With HR1 changes set to affect Medicaid redetermination processes in 2027, and Kansas recently shortening its retroactive eligibility window from three months to just 30 days, the margin for error on catching coverage gaps quickly is getting smaller.
“I feel like we didn’t have that drop this year,” Sarah said, referring to the improved visibility into Medicare Advantage plan changes. But she was candid that a lot remains unknown about how states and payers will operationalize the coming changes. “There’s still a lot of unknowns… but we hope to use this as a way to really reduce anything that might slip through the cracks.”
Advice for Other Organizations
Sarah’s advice to organizations facing similar challenges was practical: look at how easy, or difficult, it currently is to uncover what you don’t know. Go back through past eligibility denials and ask how many of those clients actually did have coverage, and how much sooner that could have been caught.
She also pointed to a bigger-picture theme that surfaced throughout the discussion: the growing need for interoperability between front-end clinical systems and back-end revenue cycle management. As Sarah put it, “I think that’s probably where all solutions are probably going to be, is a lot of interoperability between all the solutions that are provided from front end to back end.”
Crosswinds’ story is a reminder that eligibility gaps aren’t just a billing department problem, they touch clinical teams, client experience, and organizational sustainability all at once. Proactively identifying what you don’t know, rather than waiting for a denial to surface can make a meaningful difference for both your revenue and the clients you serve.
Want to see what this could look like inside your organization? Request a demo today.
