What is Revenue Cycle Management?

There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again.

As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as a whole: what it is, how it works, and the clear actions providers can take to improve the process overall.

Below is an overview of healthcare revenue cycle management and how specifically providers can improve their bottom line now and after the pandemic subsides.

What is revenue cycle management?

Any business, regardless of industry, needs to develop successful processes and strategies for remaining financially healthy. For hospitals and health systems, that process is revenue cycle management. To run a successful healthcare organization, providers must employ and manage accurate and efficient billing processes. Without it, these organizations will likely have to close their doors and will, as a result, no longer be able to provide quality care for their patient population.

How revenue cycle management works in healthcare

To put it simply, in order to generate revenue for their organization, providers need to collect payments for services rendered. The process of doing this, however, isn’t always as straightforward and simple as it seems.

Think of healthcare revenue cycle management like a journey. It starts when a patient schedules an appointment and ends when all patient payments for medical service(s) received have been collected. As we move through the journey, providers have a lot to manage, starting first with front-end intake process, moving all the way through the back-office operations to ensure payment is ultimately secured.

Phases of the revenue cycle management life cycle

The revenue cycle management life cycle spans several phases:

  • Schedule visit and secure estimate. To kickstart the process, a patient will book an appointment with a provider or specialist and administrative staff will handle insurance eligibility verification and ultimately establish a patient account for that organization. This is also an opportunity for providers to offer price transparency and provide an estimate for services to be rendered.
  • Registration and check-in. An early and vital step for optimizing the entire revenue cycle management process, this is where providers capture details like medical history, insurance coverage and other patient demographics. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office.
  • Ensure care is authorized by the payer. Still on the front end, this is where provider staff checks whether prior authorization is required for a particular procedure or service. Not securing authorization in advance of service can lead to costly denials, rework, operational inefficiencies, and a poor patient experience.
  • Receive treatment and discharge. Once the patient is discharged, the services provided will be translated into billable charges and a medical billing code will be assigned to the claim. It is crucial to the revenue cycle that these claims be accurately coded, as the re-work for incorrect codes and subsequent claim rejections can be costly and a drain for productivity.
  • Medical claims submitted. The claim must then be submitted to the payer. Submitting accurate and timely claims maximizes the revenue collected and prevents delays in reimbursement. Rejected claims directly affect an organization’s revenue cycle, making it all the more important to get the claim right before it makes its way to the payer. Even if a claim is denied, is important it be resubmitted as quick as possible.
  • Patient payments and collections. Once insurance reviews the claim and provides their reimbursement, patients are presented with their out-of-pocket costs for services rendered. On-time payments made in full are preferable for a healthy revenue cycle, but that isn’t always feasible for patients, especially now given the current environment with COVID-19. This is where quality collections practices can really help to optimize patient payments and reduce bad debt.

Challenges in revenue cycle management

Any process with this number of touch points is bound to come with challenges, but two major challenges seem to stand out: claims and collections.

Navigating healthcare claims is complex and costly. Providers and facilities often get stuck in a cycle of inaccurate claim submissions, denials, corrections and rebilling that delays reimbursement and negatively impacts financial performance.

A lot of denials can be traced back to errors within the claim submission: improper coding, issues with insurance eligibility, missing or inaccurate patient information, or duplicate claim submission. Errors like this on the front-end are a major cause of the headaches experienced by providers further down the line.

After claims are submitted, provider staff will monitor and keep track of claim status. Surprisingly, many still use a manual process not only for this, but for managing any claims that are ultimately denied. Without any kind of automation, this is a drain on productivity, time and resources and it becomes more difficult for providers to respond to denied, pending or returned claims in a timely manner for reimbursement.

Another prominent challenge in the revenue cycle is collections, notably collecting from patients before or at the point of service. Providers would prefer to collect from patients prior to them leaving the office, but it’s not always possible, and for a few reasons.

Patients are increasingly unable to pay their medical bills, more are presenting as self-pay (maybe now more than ever during the pandemic), and some may not be aware of subsequent coverage or that they qualify for charity assistance, all which directly impact providers’ abilities to collect. A lack of price transparency for services can make it even more difficult for patients to prepare financially.

Benefits of revenue cycle management

Despite its challenges, when done right, there are many benefits of revenue cycle management in healthcare.

Effective revenue cycle management not only improves the patient experience but improves staff satisfaction as well. Automating the process (billing, coding, claims management, etc.) reduces a lot of the associated administrative burden, which allows providers to focus on the delivery of quality care.

An optimized revenue cycle will also lower the rate of denials. As errors and redundancies are addressed and prevented on the front end, fewer claims will be denied.

Maybe one of the most obvious benefits of a healthy revenue cycle is maximized collections and revenue, and faster collection processes, especially when the process is automized. The entire collections process can be expedited, lowering administrative burden while also improving accuracy.

How to improve your revenue cycle management

We recommend providers take a holistic approach to improving revenue cycle management, focusing largely on automating the process and within the following four areas:

Automate access
Patient access is the starting point for the entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. patient access.

With an automated, data-driven workflow, providers can reduce the errors that lead to claim denials while simultaneously improving access to care for patients through capabilities like online scheduling. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration.

Increase collections
There is a definitely a delicate balance between ensuring that debts are collected and fostering a positive patient financial experience. It is imperative providers find a way to maximize patient collections while also increasing patient satisfaction. Patient access staff must be the patient’s advocate while also improving the organization’s ability to collect from the patient and payer.

By leveraging a data-driven approach, staff can verify patient identity and insurance coverage as well as provide an accurate estimate of payment responsibility ahead of service. Staff even can review data to assess ability to pay and evaluate various payment plan and/or financial assistance options.

The further upstream the revenue cycle can be managed the more effective the process will be to ensure the patients are informed prior to service, so they can make their portion of their payment responsibilities as early as possible to accelerate the cash collections for providers and to reduce the need to put significant effort into late stage collections.

Streamline claims
Providers can improve financial performance with automated, clean and data-driven medical claims management.

By integrating claims management software with customized edits into the workflow system, providers can thoroughly review every line of every encounter and verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement.

Encounters can be processed in real time with automatic alerts for incorrect codes or other potential issues before the claims submission. Responses include a detailed explanation of why a claim was flagged, so any necessary modifications can be made prior to submission.

Increase reimbursement
Healthcare organizations that don’t stay current on payer policy and procedure changes risk payment delays and lost revenue. It can also be difficult for providers to verify the accuracy of payment received from third-party payers.

With automated access to the right data, providers can be reimbursed more accurately and quickly, while also strengthening their relationships with payers.

Providers can avoid payment delays and lost revenue with automated payer policy and procedure change notifications. Solutions that continuously audit payer contract performance can assure that collections align with negotiated terms.

The key for successful revenue cycle management

Technology, specifically data and automation, is key to the success of the healthcare revenue cycle. Automation ensures problems don’t continue to effect productivity, and data can be matched precisely to predict, model and optimize financial results. Both can also be used to highlight a patient’s financial situation, as well as their propensity to pay, allowing providers to optimize collection strategies from the start and get patients on the right programs.

Explore Experian Health’s revenue cycle management solutions.

The post What is Revenue Cycle Management? appeared first on Healthcare Blog.

Five ways to reduce claim denials

Claims denials put a big dent into the budgets of healthcare providers – something many organizations can’t afford today given the current pandemic. In an environment where everyone must do more with less, reducing claim denials could release vital revenue and staff time to create breathing space for quality improvement.

The good news? About 90% of claims denials are preventable when healthcare providers automate revenue cycle functions. In fact, providers could gain an estimated $9.5 billion by automating the claims management processes.

Here are 5 ways for providers to proactively reduce claim denials.

Healthcare providers should shift from reactive to proactive claim denial management, looking at the whole RCM process.

On the front-end, that includes streamlining the patient registration process. By achieving near-perfect levels of accuracy on the front-end, providers can prevent costly claims denials and unnecessary re-work on the back-end of the revenue cycle.

On the back-end, ideally, providers will use technology to prevent denials in the first place, improve processes for managing denials when they do occur, and then use a robust analytics platform to understand what went wrong so it can be avoided in future.

Learn More.

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Q&A with Experian Health senior director of data compliance on CMS updates for Medicare ABN forms

As every healthcare executive knows, a healthy revenue cycle relies on precise paperwork. That’s why all Medicare providers should be paying close attention to the revised medical necessity form, which will be mandatory starting January 1, 2021. Failure to use the new Advance Beneficiary Notice of Non-coverage (ABN) form could lead to denied claims, financial penalties and a subpar patient experience.

We interviewed Theresa Marshall, senior director of data compliance at Experian Health, about what’s changed and what providers can do to prepare.

What is a medical necessity form?

Medicare only pays for services and procedures considered “medically necessary.” In situations where a procedure isn’t considered medically necessary, providers must issue the patient with an ABN which ultimately transfers financial responsibility to the patient.

Services that could be considered medically unnecessary might include treatment in hospital that could have been provided in a lower-cost setting, screening or therapies that are unrelated to the patient’s symptoms, or hospital stays that exceed a specified length of time. Perhaps a patient is receiving support with personal care from a home health agency – this may not be strictly medically necessary, so the provider might anticipate that it won’t be covered by Medicare. An ABN isn’t required for services that are never covered by Medicare, such as dental care or cosmetic surgery.

What’s changed on the new medical necessity form?

The new form, CMS-R-131, replaces the version released by CMS in June 2017. The main change is the addition of new instructions for Dual Eligible beneficiaries. These are patients who are eligible for both Medicare and Medicaid, and most likely enrolled in the Qualified Medicare Beneficiary Program (QMB), which means Medicaid pays for any Medicare-covered services. Providers must not levy any charges against QMB patients, or they’ll face sanctions. The new instructions specify that in addition to edits that strike through specific language, “dually eligible beneficiaries must be instructed to check Option Box 1 on the ABN for a claim to be submitted for Medicare adjudication.”

How should providers prepare?

Should they chose, providers can start using the new form now. The important thing to remember is that they must have the new form in place by the new year. Any outdated forms after the first of the year will be invalid.

Many providers are still using manual processes which require checking medical necessity rules for both Medicare and commercial payers via the CMS website, then calculating and preparing the required paperwork themselves. This can be time-consuming and vulnerable to errors, which also results in denied claims and extra days in accounts receivable (A/R) – not to mention the extra stress it causes for patients.

A time-saving alternative is an automated tool such as Experian Health’s Medical Necessity. With automation, you can validate clinical orders against payer rules quickly and accurately, for cleaner claims the first time around. Medical Necessity integrates seamlessly with multiple electronic medical records (EMR), scheduling and registration systems, to run automatic checks for medical necessity, frequency and duplication. With up to half of denied claims occurring early in the revenue cycle, any actions to minimize errors and delays during registration could bring big financial benefits.

Medical Necessity from Experian Health will include an automatic check of a Medicare beneficiary’s QMB status ahead of the January 2021 deadline, so the electronic ABN can be updated immediately, ready for the patient’s signature.

Could this improve the patient experience?

Yes, definitely. In addition to reducing manual processes, preventing denied claims and protecting against lost revenue and financial sanctions, automating medical necessity checks also creates a much less stressful experience for patients. For individuals who are financially vulnerable, any lack of clarity about their medical bills can be a huge source of worry. But when providers can quickly identify patients who shouldn’t be charged, the billing experience is a much smoother ride.

Medical Necessity is just one of the many ways that Experian is working to reduce the burden on hospital resources, improve patient experiences, and ensure that hospitals are fully compensated for the care they provide. Find out how we can help your organization get your paperwork in order in time for the new ABN requirements in January 2021, so you can offer a better patient experience and reduce claim denials at the same time.

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The challenges and risks associated with patient identity

Halloween is just around the corner, and while the holiday and celebration may look a little different this year (no thanks to COVID-19), the excitement over costumes and dressing up will likely remain the same.

When it comes to patient identity, however, costumes and disguises aren’t so exciting. And unfortunately, the challenges and risks associated with patient identity aren’t just limited to one day a year—they are year-round, and they are scary.

Do you know who’s standing in front of your registration desk?

Learn more about Experian Health’s identity management solutions and how we can help you match, manage and protect patient data with:

Unique Patient Identifiers

Patient Portal Security

Data Verification

The post The challenges and risks associated with patient identity appeared first on Healthcare Blog.

Technology key for hospital financial recovery following COVID-19

Financial recovery after COVID-19 is likely to
be a slow burn for most healthcare organizations, according to a recent
. Nearly 90% of
healthcare executives
expect revenue to drop below
pre-pandemic levels by the end of 2020, with one in five anticipating a hit greater
than 30%.

While the return of elective procedures will
be a lifeline for many hospitals and health systems, the road to financial
recovery remains fraught with obstacles:

  • Five months of canceled and postponed procedures need to be rescheduled
  • Worried patients must be reassured of hygiene measures, so they feel safe to attend appointments
  • Patient intake and payment processes must be modified, in order to minimize face-to-face contact
  • As the rate of infection continues to grow, providers must find new ways to also grow their revenue and protect against a further dent in profits.

The healthcare industry is unlikely to see the recovery curve hoped for across the wider economy, but digital technology, automation and advanced data analytics could help provider finances to bounce back more quickly.

4 ways technology can accelerate your
post-pandemic financial recovery

1. Easy and convenient patient scheduling unlocks your digital front door

Patients want to reschedule
appointments that were postponed or canceled over the last few months. To
manage the backlog and minimize pressure on staff, consider using a digital
patient scheduling platform
, so patients can book their
appointments online.

A self-scheduling system that
incorporates real-time
and calendar reminders will help to create a
positive consumer experience, while offering analytics and behind-the-scenes
integration to keep your call center operations running smoothly.

2. Secure and convenient mobile technology can enhance your telehealth services

is the top choice for many hospitals looking to boost revenue growth and
counter the impact of COVID-19, with two-thirds
of executives
expecting to use telehealth at least
five times more than before the coronavirus hit.

Many new digital
tools and strategies
designed to improve the patient
journey as a whole can support telehealth delivery, and help to meet growing
consumer demand for virtual care.

For those beginning
their telehealth journey, our COVID-19
Resource Center
, which offers free access to
telehealth payer policy alerts, may be the place to start.

3. A digital patient intake experience can lessen fears of exposure

Although many providers are starting
to open up for routine in-person appointments again, patients may wonder if
it’s safe. Proactive communication about the measures in place to protect staff
and patients will be essential.

Another way to minimize concern is to allow
as many patient intake tasks as possible to be completed online. Automating
patient access
through the patient portal can give
patients quicker and more convenient ways to complete pre-registration, while contactless
methods are a safe way to settle bills
without setting foot in the provider’s office.

4. Optimize collections to bolster financial recovery

Automation can also play a huge role in helping providers tighten up their revenue cycle, find new ways to enhance accounts receivable collections and avoid bad debt.

Tools such as Coverage Discovery and Patient Financial Clearance enable providers to find missing or forgotten coverage, and help the patient manage any remaining balances in a sensitive and personalized way.

Palo Pinto General Hospital uses automated coverage checks to find out whether a patient is eligible for charitable assistance within three seconds, so self-pay accounts can be directed to the most appropriate payment plan before the patient even comes in for treatment. With fewer accounts being written off, Palo Pinto has seen a noticeable improvement to their bottom line.

The pandemic has been a wake-up call for an industry that has been traditionally slow to adopt new technologies. Ahead of a second wave of COVID-19, providers must move now to take advantage of automation and digital strategies to speed up financial recovery. Contact us to find out how we can help your organization use technology to improve the patient experience, increase efficiencies and kickstart your revenue cycle.

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4 Tips for Launching Telehealth Services

With COVID-19 leading to postponed and cancelled
medical appointments, more consumers are turning to “contactless care”. Recent
figures suggest telehealth adoption has shot up from just 11% in 2019
to 46%
over the course of the pandemic, and some providers
are seeing up to 175
the number of telehealth patients than pre-COVID. As
they grapple with the surge in patient volumes alongside regulatory change,
many are playing catch-up.

For patients, rushed implementation means the
telehealth experience can fall short of expectations. Compared to the easy
one-click services available with online retail and finance platforms,
telehealth can feel clunky and frustrating. Technical issues, not knowing how
to prepare for appointments, and a lack of awareness of available services can
all taint the consumer experience.

Providers looking to launch (or re-launch) a patient-friendly
telehealth service ahead of a possible second wave should aim to check off
these four considerations before rolling it out.

1. Prioritize easy online scheduling for virtual care

Allowing patients to book telehealth appointments when it suits them will help to reduce no-shows and minimize delays. A telehealth platform that integrates with physician calendars and other patient management and record management systems will keep things running smoothly at the operational level, while creating a convenient and secure way for patients to schedule care.

For example,
when Benefis
Health System
implemented Patient
, more than 50% of patients chose to book their appointments out
of normal working hours. Sam Martin, digital developer and web specialist at
Benefis, says:

“If you’re
not allowing your patients to schedule online, you’re behind the times. You can
only benefit from it. We’re seeing the number of online bookings continue to
grow every month, confirming that this solution is working for patients.”

2. Include quick and reliable coverage checks

With the
pandemic and resulting unemployment putting both provider and patient cashflow
under strain, any available commercial or government coverage must be
identified quickly.

should run automated coverage checks to find any missing coverage and select
the right financial pathway for each patient as soon as possible. Not only will
this create a more compassionate patient financial experience, it’ll allow the
collections team to focus their attention on the right accounts and minimize
the risk of write-offs.

Automated Coverage
screens for eligibility
through Medicare, Medicaid or commercial plans, without any collections agency
getting involved.

With this tool, Essentia Health were able to find
coverage for 16,990 accounts that were assumed to be self-pay or uninsured. Kathryn
, Patient Access Director, says:

“This has
helped patients because we’re actually billing their insurance versus billing
them for self-pay. It’s helping staff because they’re billing the insurance
company much quicker. There’s less rework.”

3. Get telehealth claims right first time

Given that
the pandemic may cost hospitals an estimated $200 billion
between March and June 2020, there’s no room for the added financial burden of
claim denials. But as telemedicine expands, so does its regulatory framework. Providers
must keep track of changing payer updates and coding rules so that claims are
submitted right first time.

An automated,
data-driven claims
management tool
can help providers analyze claims with greater confidence and
spot any errors well in advance of submission. Telehealth alerts can be
included as customized edits, to confirm whether the patient’s current plan
includes virtual care. To help providers manage this process, Experian Health
is offering free access to telehealth payer policy alerts through our COVID-19
resource center

4. Protect patient data

As with any
part of the digital patient experience, a multi-layered approach to protecting
sensitive information is a must. Ideally, this will include two-factor patient
identity authentication, device recognition and out-of-wallet checks whenever a
log-in attempt looks suspicious.

Automating this process with a tool such as Precise ID allows providers to integrate multiple data points to check that a
patient is who they say they are, in a way that’s HIPAA-compliant. This makes
it harder for thieves to access patient data, without burdening the patient
with extra checks as they manage their information.

Retaining patient volume and rebuilding revenue through
“contactless” care won’t be possible unless the entire telehealth journey is as
seamless as possible. From scheduling to payment, Experian Health can help you create
a virtual patient experience that’s convenient, secure and reliable. Contact us to find out

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Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement

today expect digital capabilities from their provider and will
increasingly choose
those who offer digital capabilities. Knowing this,
many providers have been working to shift more of the patient journey online,
through telehealth and virtual care. Not all care needs to be delivered face to
face, and technological advances allow patients to access more services from
the comfort of their own homes, at a time that suits them.

This trend
has been visible for a few years now, as consumers sought out more smartphone-friendly
digital healthcare experiences. But change in the healthcare industry often
comes at a lumbering pace, so when the coronavirus pandemic hit and accelerated
the transition to remote care, many organizations found themselves on the back
foot. Now, it’s a case of catch-up, keep up or get left behind.

As demand
for telehealth services grows, so too does the regulatory framework around it.
A big part of staying competitive will be the ability to keep track of new
telehealth regulations and changing payer rules. Those that don’t will find
their collections straining under the added pressure of missed reimbursement
opportunities. How can providers stay on top of the changes and maximize

Keeping track of telehealth
reimbursement regulations

Since early March 2020, the federal government has moved to make telehealth
more accessible to patients with Medicare coverage. Limitations on the types of
clinicians that can provide telehealth services under Medicare have been
waived, while Medicare beneficiaries in rural areas and those with audio-only
phones can now access care remotely. New telehealth services will be added to
the reimbursable list under a quicker process, which is a huge benefit to both
patients and providers, but will mean the rules around reimbursement could
change more frequently.

Speaking in March, CMS Administrator Seema Verma said:

“These changes allow seniors to communicate
with their doctors without having to travel to a healthcare facility so that
they can limit risk of exposure and spread of this virus. Clinicians on the
frontlines will now have greater flexibility to safely treat our beneficiaries.”

Flexibility is always welcome – but what do looser rules mean for reimbursement workflows? Three challenges stand out:

  • Payer variation. Telehealth and telemedicine data can be presented
    differently by different payers, causing a headache for providers during
    eligibility verification.
  • Coding variation. Each type of telehealth visit is coded and billed
    differently. Regardless of where appointments are carried out, clinicians must
    still follow the same billing workflow, so keeping track of the differences is
  • Geographical variation. Providers now have to track billing and coding changes
    for telehealth services from different payers across multiple states.

What can providers do to bill telehealth services as accurately
as possible?

Billing for telehealth services more frequently calls
for a solution that’s flexible enough to keep pace with changing payer rules,
and sufficiently scalable to provide real-time reimbursement information when
it’s needed. Automation can help achieve both of these goals.

Two use cases for automation:

  • Quicker Medicare checks: Run quick and accurate checks to confirm patients are eligible for Medicare coverage for the services in question. A tool such as Coverage Discovery can comb for available coverage, even as patients are switching plans or payer rules are changing. In addition, eligibility verification automations can sweep for coverage information on telehealth services, using reliable and secure third-party data and analytics to check for updates.
  • Cleaner claims submissions: Tighten up billing workflows so that claims can be submitted as soon as possible. Claims management software can run automatic checks so that every claim is submitted clean and error-free. Any missing or incorrect codes can be flagged up, eliminating costly and time-consuming rework. Telehealth alerts can be included as customized edits to confirm whether virtual care is a benefit included in the patient’s current plan.

While these actions can help protect your
bottom line during the immediate crisis, they’ll also help you build a solid
foundation as your telehealth offering inevitably continues to grow. Whether
you’re looking to verify coverage, check eligibility or protect patient
identities as they log in and use telehealth services, reliable data is key.

a free consultation
to discover how Experian Health can help you leverage
accurate and real-time data insights to optimize your billing workflow and
maximize telehealth reimbursements.

The post Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement appeared first on Healthcare Blog.

Medicare MBI: COVID-19 and Medicare Claims

At the
beginning of the year
, the healthcare industry moved away
from Medicare identifiers based on Social Security Numbers (SSNs), in favor of
more secure Medicare
Beneficiary Identifiers (MBIs)
. As with
any large-scale change program, the shift was unlikely to be completely clear
sailing. But with the coronavirus pandemic landing shortly after the 21-month transition
period was due to conclude, the switchover has been rougher than expected.

Impacted Care

Care providers are discovering newly eligible Medicare
beneficiaries who haven’t yet received their card, while existing beneficiaries
have misplaced theirs. Without
a valid MBI number, patients risk delayed access to care, while the admin
process to sort it out can be stressful, especially for already-vulnerable
senior populations.

For providers, the
extra work and delayed reimbursements are particularly unwelcome when COVID-19
is already putting pressure on services and squeezing revenue. Unprecedented intake
conditions where staff and patients are trying to limit face-to-face contact
makes it difficult to complete the usual coverage checks. As a result,
providers are missing revenue opportunities they cannot afford, while incurring
additional downstream costs when collections are delayed.

Experian Health
clients are optimizing Coverage Discovery to speed things up.

Case study: how one healthcare provider is
finding missing Medicare coverage faster

For example, the southeast division of a
national health care system, with 1700+ beds and $1.6B in revenue, needed
better ways to find MBIs when Health Insurance Claim Numbers (HICNs) were
phased out. Assisting Medicare patients with tracking down their MBIs was
time-consuming and error-prone. They came to Experian Health to find a more
efficient way to check Medicare coverage.

Jason Considine, Experian Health’s Senior Vice
President for Patient Collections and Engagement, says:

“We knew we could help because we already had
Medicare coverage history through our historical repository. As a test, we were
given a control set of known Medicare patients without MBIs, and were charged
with finding those patients’ MBIs and Medicare coverage.”

Experian Health’s Coverage
tool was used to batch-process the control
set. This took less than a day, as the tool scans more than one million
accounts daily, using historical and demographic data, synthesized with
multiple proprietary data sources, to find unknown or forgotten coverage. In
this case, the resulting data was collated via batch files, but could be
integrated with other coverage and collections tools, such as eCareNext,
which automates the more repetitive and hands-on pre-registration tasks.

Coverage Discovery found 60% of the Medicare
coverages with MBIs, plus additional coverages. This enabled the provider to
file claims that would otherwise have been nearly impossible and very time

The provider’s next steps will be to integrate
Coverage Discovery with eCareNext, and roll it out to more of sites in the

Could Coverage Discovery help your
organization find missing MBIs?

Capturing better insights into productivity,
financial results, and staff workflows is always valuable. But in the current
crisis, tool that maximize reimbursement and automating the tasks that take up
staff time is essential.

Through our historical data repository,
Experian Health’s Coverage
already contains many patient MBIs – and it’s
continually updated. We can help you search for Medicare coverage and make sure
your clients find their MBIs, easing pressure off your revenue cycle management
teams during this extremely challenging time.

Request a review of
Coverage Discovery and improve your coverage and collections processes.

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How to avoid patient misidentification and claims denials amidst COVID-19

For many of the 36 million
who have registered for
unemployment benefits during the coronavirus outbreak, losing their job means losing
their health insurance. Options for the newly-unemployed are limited yet
complicated: while the federal
has declined to reopen
enrollment under the Affordable Care Act, several states are supporting those
without coverage by opening emergency
enrollment periods

for state-based health exchanges. Those that can afford it may extend their existing
employer plan through COBRA, while those that can’t may apply for Medicaid. But
unfortunately, millions will be left without coverage.

Now, with these changes
happening in both large quantities and at rapid speed, the process for checking
a patient’s coverage status is more complex, time-consuming and susceptible to
errors than in normal circumstances. Further errors may appear as patients are
forced to switch care teams, leading to disjointed care and incomplete,
inaccurate or duplicate health records.

It’s a huge administrative
and financial burden for providers, who must keep pace with changes to the
health insurance landscape or risk a surge in denied claims as a result of
patient misidentification. How should they guard against patient identity errors
and minimize revenue loss in the wake of COVID-19?

to prevent mismatched patient records and avoidable claims denials

A 2018 survey found a third of denied healthcare claims were caused by patient identity errors, costing hospitals an average of $1.5 million. We may see this figure creep up following COVID-19, unless providers move quickly to implement robust identity proofing and patient matching processes. Providers looking to do this should consider prioritizing the following three areas:

  • Eliminate errors during patient registration

Up to half of denied claims occur earlier in the revenue cycle, which is also when most duplicate medical records are created. Improving identity proofing during patient scheduling and registration is a logical place to focus, to ensure records are accurate from the start.

This should include proactively checking for active coverage as early as possible. Using a Coverage Discovery tool that automatically finds available coverage will help avoid bad debt write-offs and give patients peace of mind. Essentia Health’s Patient Access team were able to find 67% coverage pre-service, for patient accounts that were previously considered self-pay or uninsured.

  • Automate identity matching throughout the revenue cycle

When patient records are incomplete, duplicated or overlaid with part of
someone else’s record, denied claims become an accepted cost – but they’re
often avoidable.

Instead of time-consuming and error-prone manual checks, providers should consider using automated identity management software to ensure patient records are accurate and complete. Data-driven matching technology supported by a Universal Patient Identifier allows a single view of each patient to be shared safely and securely across multiple healthcare services. There’s no need for tedious reconciliation work and providers can be confident they’re submitting clean claims each time.

  • Improve identity management protocols for telehealth and mobile services

More patients turning to telehealth services and patient portals to
minimize face-to-face contact, putting pressure on providers to solve the
patient matching problem. And with payers expanding coding for reimbursements
for telehealth and remote services, there’s an added imperative to make sure
patient information is accurate in order to minimize the risk of claims

Victoria Dames, Senior Product Director at Experian
Health, says portal access has increased by roughly 40% since the start of the
coronavirus outbreak, and explains that the rise in telehealth and mobile
services means identity proofing must be a priority:

“If you don’t already have identity proofing and automated solutions for
patient matching in place, you’ll have duplicate records. We don’t want that –
it’s important to have one view of the patient. But we need to move quickly.
Automating for identity proofing eliminates the risk of human error and it’s
faster too, which is crucial right now. We know many providers want to get
their identity management and claims management systems optimized quickly, so
we have a team set up to help.”

the right technology to verify patient identities and analyze claims, avoidable
denials resulting from missing or incorrect information can be caught sooner.

to find out how we can help
your organization manage patient identities to eliminate costly claims denials
during and after COVID-19.

The post How to avoid patient misidentification and claims denials amidst COVID-19 appeared first on Healthcare Blog.

How automating charity care eligibility improves the patient financial experience

There’s a phenomenon in online product reviews
where the customer seems to love their purchase, yet gives it only one or two
stars. Why do they do this? Poor customer service: the item was delivered late,
questions went unanswered, or payment processing was disorganized. When the consumer
experience falls below expectations, the brand suffers – no matter how good the

The same thing happens in healthcare. The clinical
care may be outstanding, but if the patient finds billing frustrating or
confusing, it’s those feelings they’ll associate with the overall experience. Many
healthcare providers suffer reputational damage because the patient financial
experience fails to match high quality clinical care.

This is especially true for patients who find
themselves without coverage and in need of financial assistance, which is often
an extremely stressful process. And with unemployment
levels soaring
as a result of the coronavirus
pandemic, it’s likely more Americans will need to explore eligibility for
charitable support. Finding smarter, speedier and scalable ways to check
charity care eligibility is even more important.

Using automation for faster charity care

Automation may be the answer. With a system
that runs checks quickly and easily against vast databases of up-to-the-minute
records, providers can discover a patient’s propensity to pay before treatment
is even carried out. Clarity from the outset ensures the patient is put on the
right payment pathway and lays the groundwork for a positive
patient financial experience

Caye Mauney, Patient Access Director for Palo Pinto General Hospital,
tells us how her organization used data-driven financial clearance checks to improve
the patient financial experience and reduce bad debt:

  1. Speeding up checks for earlier eligibility decisions

Prior to using automation, Palo Pinto General used a time-consuming
and labor-intensive paper-based process to determine a patient’s eligibility
for charity assistance. But with automated screening prior to or at the point
of service, the hospital can now verify whether patients qualify for charitable
assistance within three seconds, and quickly connect them to the right program.
For those with a self-pay amount, a Healthcare Financial Risk Score can be
calculated using historical payments information and credit history, to help
determine the optimal payment plan.

Mauney says: “All the information we need is now at our
fingertips. The patient no longer needs to bring in check stubs or go back to a
former employer to ask for information. It’s been a game changer.”

  • Creating a personalized patient experience

At Palo Pinto, staff wanted to make sure that patients were taken
care of not only medically, but financially too. Just as each patient needs
medical care tailored to their individual needs, so too should their financial
accounts be handled on a case by case basis.

With custom payment plans based on an individual’s unique
financial situation, the payment process can be transformed into an experience
that patients no longer dread or avoid.

Automated patient
clearance checks
draw on multiple sources of data and run analytics to quickly
determine the best option for each patient. It can also generate scripts for
patient advocates to use, to help patients navigate the process more easily. Palo
Pinto reports improvements in patient satisfaction and trust as a result of uncomplicating
the patient experience
in this way.

  • Reducing bad debt and increasing point-of-service collections

Seamlessly connecting patients to the right financial assistance
program allows patients to focus on their treatment, while feeling reassured
that their financial obligations will be met. For providers, swift processing
means decisions are made quickly, resulting in fewer accounts receivable delays
and a lower risk of uncompensated

At Palo Pinto General, quicker charity applications means more are
being approved, and therefore not written off as bad debt – ultimately helping
their bottom line.

Discover how automating checks for charity care eligibility with Patient
Financial Clearance
can help your organization increase productivity,
improve collections and boost patient satisfaction.

The post How automating charity care eligibility improves the patient financial experience appeared first on Healthcare Blog.