Four strategies to optimize patient collections

Experian Health products referenced in this blog post:

Healthcare may be historically more recession-resistant that other industries, but the COVID-19 pandemic has left many providers hurting financially, as many patients struggle to pay their bills. Patient collections were already a challenge, with declining Medicaid coverage and rising co-pay obligations putting patients on the hook for more of their healthcare expenses. Now, with millions of Americans out of work and missing out on employer-sponsored insurance, providers are being forced to adapt their collections processes to fit this unstable insurance landscape, or risk losing more dollars to bad debt.

Four key strategies can help providers seal the cracks in patient collections and stem the surge in uncompensated care. With compassionate processes that treat each patient as an individual, providers can use data and automation for more efficient healthcare charity screening, find missing coverage and identify both propensity to pay and the best financial pathway to minimize the chances of bills going unpaid.

1. Screen for charity eligibility early and often

Nearly 4 in 10 unemployed Americans have been without work for more than 27 weeks – the most since November 2013. As unemployment persists and benefits dwindle for many, more patients may be eligible for charitable support to cover their healthcare costs. Running presumptive healthcare charity screening as part of the collections workflow can help providers identify those who should be getting extra support.

Patient Financial Clearance runs automated checks when a patient registers, so individuals can be automatically enrolled as soon as eligibility is confirmed. Checks are repeated throughout the patient journey, should their financial situation changes.

Caye Mauney, Patient Access Director for Palo Pinto General Hospital, says the automated checks can confirm eligibility within just three seconds. This saves a huge amount of time for her team, while giving patients financial clarity without worrying waits: “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.”

2. Find forgotten coverage quickly 

Automation can help providers cut uncompensated care by finding missing and forgotten coverage, even when patient case mix and payer rules are constantly changing. Healthcare organizations that quickly uncover previously unidentified coverage are often are paid sooner and avoid the collections challenges of self-pay receivables.

Experian Health’s Coverage Discovery uses best practices around search, historical information, multiple proprietary data sources and demographic validation to find previously unknown coverage. It continuously scans for insurance coverage to maximize reimbursements and minimize accounts sent to collections and to charity.

Learn from Banner Health how Coverage Discovery has helped the organization find 30+% unidentified coverage earlier in the revenue cycle.

Register for the webinar here.

3. Improve the collections experience with compassionate billing

Speedy coverage checks are just one way to give patients peace of mind when it comes to medical expenses. The collections process is often opaque and intimidating, hitting patients when they’re already stressed and vulnerable. The more compassion that can be built in, the better the patient financial experience will be. Unpaid bills go down, while patient loyalty goes up.

Transparent pricing, data-driven payment plans, personalized communications, and easy ways to pay all contribute to a positive patient financial experience. A good place to start is with Collections Optimization Manager, which allows providers to segment, support and monitor patients throughout the entire collections cycle. By connecting to a host of other patient-facing tools, this helps members feel taken care of from start to finish.

4. Use data to put patients on best payment pathway

None of these strategies will work without reliable, accurate data. Healthcare organizations traditionally rely on demographic and behavioral datasets, but this leaves gaps in how much is known about patients’ financial situations. Incorporating credit data can add a layer of valuable insights about a patient’s propensity to pay, so collections resources can be directed to the appropriate accounts. If you know a patient has a missed mortgage payment or delinquent loans, you can help them find alternative coverage and redirect them to a better payment pathway.

Experian Health combines demographic, behavioral and credit data so you can help your members navigate their health expenses with confidence. The result? Better financial health for both your members and your organization.

Find out more about how to optimize patient collections, whatever 2021 has in store, in our recent eBook, Recession-proof your revenue cycle. 

Download now.

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Success at a glance: finding unidentified coverage

It is estimated that 30-50% of denied claims occur on the front end during the patient access process, namely during registration, authorization and eligibility. Unfortunately, manual patient intake processes contribute to these denials, and ultimately, the bottom line, staff productivity and the patient experience take the hit.

Banner Health chose to automate its patient access processes with eCare NEXT from Experian Health. The solution, which integrates directly with Banner Health’s acute and ambulatory electronic health records (EHRs), automates the organization’s preregistration workflow, including medical necessity and financial clearance. This improves registration accuracy, provides more accurate patient estimates and reduces the number of denials on the front end.

Banner Health has benefited by incorporating a mix of Experian Health products that integrate directly and collaborate with other technologies and workflows already in place:

  • Decrease in eligibility errors. With eCare NEXT, initial denials due to eligibility errors have been reduced by $30M in the first quarter alone since going live with Experian Health.
  • Significant cost savings. With more accurate estimates, Banner Health has seen significant cost savings on the front end from more efficient coverage discovery. The system is consistently finding 30+% unique or new coverage in the patient access workflow.
  • Improved staff engagement and satisfaction. Automation has greatly reduced manual inputs, enabling staff to focus more on the patient rather than systems and logins required for patient intake.

Our partnership with Experian Health helps Banner Health’s revenue cycle team deliver on its mission of “getting it right, at the right time, every time.” 
— Becky Peters, Executive Director of Patient Access Services, Banner Health

Want to learn more about Banner Health’s success in finding unidentified coverage earlier in the revenue cycle? Sign up for the January 21 webinar below, where attendees will gain insight into the organization’s proven workflow and processes.

Register here.

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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.

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2021 Patient Experience Predictions

As 2020 draws to a close and headlines hint that the end might finally be in sight for the pandemic, the healthcare industry is considering COVID-19’s legacy. The sudden shift to contactless care, financial consequences of widespread social distancing measures and changing expectations of the patient experience have upended the world of healthcare and health IT – but which changes are here to stay? And what do these changes mean for the patient experience in 2021?

We asked several leaders across Experian Health for their predictions in the areas of patient access, collections, and identity management, and here is a preview of what they had to say:

“Patients will choose providers that give them control over their healthcare experience”

Patients have more opportunity today than ever before to manage their healthcare experience from the comfort of their own home, whether that be through patient portals, online self-scheduling and registration or online payment tools.

As lockdowns and social distancing prevented patients from presenting in person, providers were forced to offer patients with more options for self-service. Unsurprisingly, this was a move a lot of patients have been waiting for and many welcomed this new technology with open arms.

Jason Kressel, senior vice president of consumer products and analytics at Experian Health, expects that, as patients become more accustomed to this level of self-service, more than half of consumers will change providers in favor of one that offers premium digital healthcare services:

“Providers who can meet patients where they are—through web-based services and via their mobile devices—will have the most success with retaining and attracting patients.”

Online self-scheduling can put patients in the driver seat while also avoiding unnecessary contact while many remain cautious about on-site visits. With access issues removed, the patient experience will improve, in turn improving health outcomes (and providers’ bottom lines!).

“With hospital finances on shaky ground, collections will be a top priority for survival”

As COVID-related unemployment leads to an unstable insurance landscape, many providers are worried about maintaining effective collections processes, and they cannot afford to spend time chasing payments. Guarding against uncompensated care and tightening up the collections process will be essential.

Automated collections software can help collections teams focus their efforts on patients who are most likely to pay, while also helping patients manage their financial obligations with as little stress as possible. Providers can also quickly determine which patients qualify for financial assistance, helping them get them on the right payment pathway for their circumstance without delay. Not only will this provide a much better patient financial experience, it’ll prevent “lost coverage” and allow providers to collect a larger portion of dollars owed.

“The surge in portal usage means providers need to watch out for fraudsters”

What does the rapid growth in portal uptake mean for data security? The speedy rollout of telehealth and other digital services has exposed security concerns for many providers, who fear a rise in fraudulent activity in 2021 as cybercriminals sniff out opportunities to steal patient data.

To protect patient information and avoid costly reputational damage, providers must adopt more sophisticated identity management solutions. By combining cutting edge identity proofing, risk-based authentication and knowledge-based questions, providers can more easily verify a patient’s identity when they log on to their portal, greatly eliminating the risk of fraud.

Interested in learning more about other trends that could affect the patient experience moving forward?

View the Experian Health 2021 Patient Experience Forecast.

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How to improve collections and patient satisfaction with contactless payments

How did Starbucks lose $1.2 billion in sales during the pandemic, but still exceed revenue expectations in the last quarter?

The answer lies in contactless mobile payments. By making it possible for coffee lovers to pre-order and pay for their morning cappuccino through a mobile app, the company was able to offer a safe and convenient slice of normality during the pandemic. While stores were limited to drive-thru and takeout, customers could still get their caffeine fix, but in an easy, socially distanced way. And customers want convenient and contactless ways to pay – as evidenced by $6.2 billion in quarterly sales. Thanks to the app introduced a few years ago, the company has been able to withstand much of the disruption that’s hit the rest of the industry hard.

Can healthcare providers learn from Starbucks’ strategy? Yes. Social distancing measures and fears about face-to-face contact are preventing many patients from visiting healthcare facilities and it’s becoming harder for providers to collect payments and maintain a steady revenue cycle. Self-service and contactless payment methods are now a necessity if providers want to remain profitable during these uncertain times.

But it’s not just about facilitating payments in the context of social distancing. Even before the pandemic, patients were looking for more convenient ways to manage their out-of-pocket expenses and thinking more like active consumers than passive participants in their healthcare journey. Starbucks’ story shows how prioritizing the consumer experience wins out in the end.

So how do providers accelerate collections, ensure patients and staff remain safe, and keep up with consumer expectations? Here are three ways to use pre- and post-service online and mobile payment tools to optimize both collections and consumer satisfaction:

3 ways to improve the patient financial journey with easy contactless payments

1. Empower patients with upfront payment estimates

Imagine sending patients an email or text as soon as their appointment is scheduled, with a personalized cost estimate, relevant payment options and convenient ways to pay before they even arrive. Healthcare payments could be as easy as ordering and paying for a coffee!

With Patient Financial Advisor and Patient Estimates, providers can do just that. With a single text message, providers can give patients transparency, control and reassurance about what they’re going to owe and how they can settle their bill quickly and easily.

2. Help patients find the right payment plan

The pandemic means finances are tighter than usual for many families as well as many organizations, so helping patients manage their bills and get on the right plan pre-service is especially important.

With a consumer-friendly online portal, patients can check their balances, manage payment plans and apply for financial support at the tap of a button. Quicker insurance checks will also increase the likelihood of faster payments and minimize the risk of claim denials for providers.

3. Make it easy to pay – before or after treatment

Reducing friction at the point of payment is probably the biggest dial-mover when it comes to accelerating collections. If patients can settle their bill at the click of a button, the job is ticked off quickly without too much effort on their part, and with minimal input from providers taff. Why make paying harder than it needs to be?

Consider offering patients safe and secure digital payment methods that they can access anytime, anywhere, both before and after their appointment. Post-service, maintain a positive consumer experience with proactive follow-up, timely account information and options to navigate payments from home, if not already settled.

The pandemic has intensified the need for healthcare payments to evolve. Contactless and mobile payments can keep revenue coming in the door (even when the real doors are shut). And as Starbucks has shown, consumers expect easier ways to pay. Every day that a patient struggles to pay a bill is a missed opportunity for the bottom line.

Find out more about how pre- and post-service contactless payments could help your organization withstand financial turbulence, during the pandemic and beyond.

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Success at a glance: patient-centric collections

With high-deductible health plans, larger out of pocket costs, and confusion about medical costs in general, it’s no surprise that patients today face increased financial responsibility. Unfortunately, the current pandemic has introduced an entirely new level of financial responsibility and uncertainty for both patients and providers.

Like many provider organizations across the country, Yale New Haven Health was feeling the impact of the changing healthcare landscape. Patients are finding it harder and harder to pay their medical bills, and more accounts are going to debt. The organization obviously needed to be compensated for their services and improve collections, but it needed to do so in a way that matched its mission and vision of providing high value, patient-centered care.

A few years ago, Yale New Haven Health turned to Experian Health to improve collections with an elevated patient experience.

With Experian Health’s Collections Optimization Manager, Yale New Haven Health was able to score and segment patient accounts based on who has the propensity to pay, determine how a patient could best resolve their bill and then direct them to the appropriate resources for doing so. The organization supplemented this activity with PatientDial, a cloud-based dialing platform that offers inbound and outbound communication options to increase collections.

While these efforts have improved collections for the organization in the past, they have proven invaluable for both the revenue cycle and the patient experience during COVID-19.

  • Increased patient satisfaction. A billing indicator was included for patients that might be experiencing financial hardship as a result of COVID-19, allowing the organization to hold that particular billing statement for 90 days. After 90 days, those accounts were again reviewed and evaluated for charity care as necessary. Patients have been grateful for the extra time and flexibility for payment during such a stressful event.
  • Continued collections. With these steps in place, Yale New Haven Health was able to maintain the regular daily statement production and movement of accounts through the revenue cycle for those not experiencing COVID-related hardship. The additional revenue supported the institution and helped to maintain collection levels as close to normal as possible during uncertain times.
  • Improved communications. Even with the 90-day delay for select accounts, call campaigns with PatientDial continued throughout the pandemic. Connection rates have increased by 5.5% month over month from January to present. Patients are not only pleased with the communications over balances due but are more receptive to attempts to resolve debt as the organization has approached billing-related communications in a more empathetic manner.


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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Success at a glance: improved collections, part two

While all hospitals and health systems will no doubt encounter revenue-specific challenges related to the pandemic, a solid foundation and targeted approach for improved collections can help speed up the road to recovery. In fact, it was Sanford Health’s unique approach to increasing patient collections that allowed it to both optimize collections during the pandemic and improve employee satisfaction and retention.

Several years prior to COVID-19, Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies.

Leveraging Collections Optimization Manager and PatientDial from Experian Health, Sanford was able to quickly and easily streamline call center operations and increase collections in a myriad of ways – through new and updated patient addresses, patient-friendly billing statements, identifying new guarantors and more.

With the above items in place, Sanford was already well positioned to seamlessly manage normal business operations during a pandemic. The organization was able to quickly adapt, and then build on that momentum to better serve its patients and staff, while also driving results.

Since the start of COVID-19, Sanford has:

  • Increased employee satisfaction with remote capabilities
    PatientDial allowed Sanford to seamlessly transition its call center team to work remote. Where about 30% of the workforce was remote prior to COVID-19, just shy of 99% of call center representatives are now remote. This has been a great source of employee satisfaction and safety and has aided in the system’s ability to keep the collections momentum going.
  • Provided a more compassionate approach to collections
    Recognizing that this is a sensitive time for many, Sanford ensured the proper mechanisms were in place to identify those who required additional help, offering the best methods for collection possible. Sanford has not only created a billing indicator for patients affected by COVID-19, but Experian Health has provided additional insight with a weekly file of patients who are identified as possibly financially stressed.
  • Improved collections during time of crisis
    While collections decreased for the quarter, Sanford saw a record increase in collections for the month of March — $800K more than the system saw in March of 2019.


Learn more.

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Success at a glance: improved collections, part one

Before working with Experian Health, call center operations at Sanford Health were disparate and disjointed, with each call center operating on a different phone system with different carriers. While some centers saw high abandonment rates, others were waiting around for calls. Although Sanford attempted to create balance by placing accounts in a work queue, the process for managing outbound collection calls remained manual and it was impossible to identify and strategically contact patients based on ability to pay.

Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies.

Since working with Experian Health, Sanford now has a focused approach to managing accounts receivable (AR) by identifying patients with a certain propensity to pay. Collections Optimization Manager allows Sanford to quickly identify a pathway and delivery to resolution of the patient’s balance.

The analytical segmentation models within Collections Optimization Manager use precise algorithms that reveal those patients who likely are eligible for charity services, those who might prefer to pay in full at a discount, or those who might benefit from a payment plan. The solution then feeds segmentation data to PatientDial, which Sanford uses to route calls to 70 patient account representatives.

Sanford also implemented a re-designed, more user-friendly patient statement format. The improved cover page offers easy-to-understand information about the bill including the available options for payment.

In a larger effort to improve the patient experience, Sanford implemented an employee incentive program that appropriately rewards staff based on their collections’ performance.

Since working with Experian Health, Sanford has seen the following improvements:

Streamlined call center operations. With PatientDial in place, Sanford was able to consolidate its call center team members in 4 regions and seamlessly operate on centralized toll free and direct dial numbers. Where it used to take on average 56 seconds for a call to be answered, calls are now answered in 20 seconds or less. The system now comfortably manages an average of 12,000 inbound calls weekly.

Increased collections. The model in place has allowed Sanford to improve collections in a myriad of ways. In addition to increased collections from calls made through PatientDial, Sanford was able to see an additional $2.5M in patient payments by ensuring patient statements were sent to the new or correct address. The system found an additional $60K by identifying new guarantors for accounts of deceased patients. The segmentation capabilities from Experian Health also enabled Sanford to identify patients struggling with bankruptcy, allowing staff to focus their efforts on collectible accounts and more efficiently direct individuals to charity options.

Learn more about Sanford Health’s journey and how a similar approach could help your organization improve collections and employee satisfaction.

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Finding unidentified coverage without a Social Security Number (SSN)

Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve collections, providers are often tasked with finding this information on the spot. Historically, providers have used demographic information like Social Security Numbers (SSN) as a means to verify patient identities and locate this information, but that tactic is increasingly unreliable as it is possible for more than one person to use the same SSN and SSNs are a lucrative route to stealing someone’s identity.

With this in mind, many health plans are no longer using SSNs as an identifying number for insurance coverage. In fact, the Centers for Medicare & Medicaid Services recently removed SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status.

The latest health plans to remove this piece of demographic information is Health Net Medi-Cal and Health Net National. Effective September 25, 2020, the search options for eligibility for this plan have changed. Providers will ONLY be able to find and verify coverage with a subscriber ID.

“Providers are often tasked with finding this information on the spot.”

While Health Net Medi-Cal and Health Net National are the latest health plans to do away with demographic searches, it’s certainly not a surprising trend and more will likely follow suit.

Bridging the gap with historical data

Uncovering previously unidentified coverage is critical for providers as it helps to eliminate costly self-pay situations, bad debt write-offs and unwarranted charity designations. And, without the proper insurance information, patients also risk delayed access to care and other financial hardships.

With demographic searches on the decline, providers will need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage.

Combining search best practices, multiple proprietary databases and historical information, Experian Health’s Coverage Discovery locates patients’ billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process.

A tool like Coverage Discovery is even more beneficial for providers during COVID-19, where limitations of face-to-face contact make it more difficult to complete the usual coverage checks. Coverage Discovery empowers providers to facilitate coverage checks remotely, avoiding delayed reimbursements during a time when revenue streams are already feeling pressure.

“As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage.”

Want to learn more? Contact us to see how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.

The post Finding unidentified coverage without a Social Security Number (SSN) appeared first on Healthcare Blog.

Is COVID-19 another catalyst for price transparency?

Few of us would buy a new car or TV without
checking the price tag first. Why should our healthcare be any different? Yet
this is exactly what many patients are forced to do when they need medical tests
or treatment.

Following the breadcrumbs on a provider’s
website is a time-consuming and confusing way for patients to piece together a price
estimate. Even with a rough idea of the cost of care, variations in health plan
pricing often bump up the final bill. The lack of transparency is stressful for
patients and costly for providers, who end up chasing slow payments and losing
revenue to bad debt. But could things be about to change?

Many providers have been proactive in
offering transparent pricing, and thanks to recent regulatory changes, this could
soon be an industry-wide requirement. The CMS
Price Transparency Final Rule
mandates that by 1 January 2021, hospitals
should publish consumer-friendly pricing information on certain ‘shoppable’
services, to help patients understand and plan their bills ahead of time. The
proposed Health
PRICE Transparency Act
would similarly compel providers to publish real
cash prices alongside rates negotiated with insurers. As households, businesses
and public bodies grapple with the economic impact of COVID-19, any additional
clarity around pricing that could help make a dent in healthcare-related debt
is to be welcomed.

Liz Serie,
Director of Product Management and Patient Experience at Experian Health, says
that regardless of changes to the regulatory landscape, pricing transparency is
here to stay:

“It’s great for the patient because they
have visibility, transparency and clarity about what they owe. They can prepare
financially before their visit, so they can focus on what matters most –
healing. Providers are excited about price transparency tools because they let
patients pick and plan payment options, reducing the total cost to collect. And
with more reliable billing data, it’s a win from a decision-making perspective
too.”

Transparency is becoming the norm in other
aspects of healthcare consumer experience, and billing should be no different.

4 steps to fast and simple patient-friendly
pricing

1. Remove the guesswork with accurate, upfront pricing estimates

No one wants to play detective with their deductibles. Giving patients pricing information upfront puts them in control of their payments, improving their engagement and increasing the likelihood of faster collections – a top priority for providers today as they continue to feel the effects of COVID-19 on the bottom line.

A Patient
Estimates tool
can generate accurate, easy-to-understand estimates based on
known treatment costs, payer rates and real-time benefits data. Estimates and
secure payment options can be sent straight to the patient’s mobile device,
improving the patient financial experience with a single text message.

2. Give patients 24/7 control through their online portal

With COVID-19
pushing even more of our lives online, a 24/7 patient portal is a must for
providers that want to stay competitive.

Yale New Haven
Health (YNHH) used PatientSimple
to give patients a mobile-friendly, self-service portal through which they can
generate price estimates, choose payment plans, and monitor payment
information. Sharlene Seidman, Executive Director Corporate Business Services
at YNHH says patients have welcomed online access:

“ROI is not just
tangible dollars in additional revenue, it’s patient satisfaction and improving
the financial experience.”

3. Minimize delayed payments with quicker insurance checks

Millions of Americans have experienced sudden job
losses or changes to their insurance status in the wake of the pandemic,
causing confusion about their current coverage. Payment delays and denied
claims are an inevitable side-effect. Providers can help by offering fast,
automated insurance eligibility verification, so patients can confirm coverage at the point of
service and take the next steps with confidence.

4. Move to mobile for a more convenient patient experience

Imagine if your patients could have all the information they need about their healthcare account, right there in their pocket. Patient Payment Solutions offer real-time pricing estimates based on provider pricing, payer rates and benefit information, so patients can review their bill at a time and place that suits them. There’s also the option to offer secure and contactless payment methods, so they can settle their bill at the click of a button.

Estimates
suggest
that
the average family of four could save up to $11,000 a year if they had the
option to choose care on the basis of more transparent pricing. Savings on this
scale mean that demand for clear information about out-of-pocket expenses is
going to soar, whatever happens with price transparency regulations.

Learn how Experian Health can help your
organization support patients and improve collections through more transparent
pricing.

The post Is COVID-19 another catalyst for price transparency? 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
survey
. 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
scheduling
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

Telehealth
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
payment
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.

The post Technology key for hospital financial recovery following COVID-19 appeared first on Healthcare Blog.

Five Keys to Tackling Flu Season as it Collides with COVID-19

With a vaccine for COVID-19 thought to be at least a year away, healthcare providers are steeling themselves for even more cases in the fall. The big worry is that a surge in cases will hit the health system just as flu season takes hold. In a recent interview, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC), warned that “the assault of the virus on our nation next winter [may] actually be even more difficult than the one we just went through… we’re going to have the flu epidemic and the coronavirus epidemic at the same time.”

Healthcare organizations are accustomed to
an influx of sick patients between October and March: around
62,000
people died and more than 700,000 were hospitalized during last
winter’s flu season. With 130,000
Americans
losing their lives to COVID-19 in just four months, what could
happen when the two respiratory diseases collide?

Large numbers of patients with either virus
(or potentially with both) will put renewed pressure on staff and services that
are already under immense strain. Hospitals will need to prepare to manage both
groups of patients as efficiently and safely as possible.

Five ways to ease stress, paperwork and
patient concerns ahead of a dual epidemic

1. Use data to drive your patient engagement strategy

Create a flu
preparedness patient engagement strategy
to keep patients informed of how
best to protect themselves in the context of a dual epidemic. As a result of
the coronavirus pandemic, patients may be more familiar with telehealth
services as a “contact-free” alternative to in-person appointments, so you’ll
want to continue to promote these to minimize the spread of infection.

With consumer
data
, you can segment patients according to risk and automate your
communications, so they get the most relevant message at the most convenient
time.

2. Relieve pressure on staff with automated patient scheduling

Digital scheduling gives
patients the option to book appointments online, at a time and place that suits
them. This reduces pressure on call center staff and can give providers control
over the volume and timing of in-person appointments, thus helping to reduce
the spread of germs.

An online
patient scheduling platform
can automate the entire scheduling process,
integrating in real-time with your records management systems and connecting to
your referral providers’ systems for a seamless patient and staff experience.

3. Screen patients proactively to discover their needs ahead of time

Asking patients to fill out electronic
questionnaires before their visit means their access needs can be identified
and addressed before they come in. Do they need help to find transportation?
Will they face any challenges in picking up a prescription? Is there something
that could stand in the way of follow-up care?

Screening for social
determinants of health
can answer these questions so you can
direct patients to the most appropriate care and support.

4. Enable digital patient registration for a quick and easy intake experience

Speed up the registration process by giving patients the option to complete their intake admin by phone or through their patient portal. Not only will this reduce the spread of infection in busy waiting rooms, it’ll make for a more enjoyable patient experience and free up limited staff resources for other priorities.

With automated
registration
and consumer-facing mobile
experiences, you can improve the patient experience, operational efficiencies
and data accuracy all at the same time.

5. Minimize in-person interactions with contactless payments

Encourage patients to clear their balances without
having to hand over cash or access payment kiosks. Self-service digital
payment tools
allow patients to make contactless
payments through their patient portal or from their mobile device.

It’s in line with consumer expectations, and
it could also increase patient collections: Saratoga Hospital
saw point-of-service collections increase by 50% after implementing more
user-friendly patient payment options.

“The combined pressure from two viruses hitting health systems at once means it’s even more important for providers to leverage data for speed and accuracy. Automated workflows can help accelerate operational efficiency, as well as create a better patient experience during what’s already an extremely stressful time.”

Karly Rowe, Vice President of Product Development for Experian Health

Find out more about how Experian Health’s expertise in data and analytics can help your organization prepare for the coming flu season so you can offer your patients a safe, accessible and stress-free experience.

We have also developed a checklist of action items for providers to consider as you prepare for both flu and COVID-19. How ready are you? Which actions is your organization instituting now?

The post Five Keys to Tackling Flu Season as it Collides with COVID-19 appeared first on Healthcare Blog.

Five keys to tackling flu season as it collides with COVID-19

With a vaccine for COVID-19 thought to be at least a year away, healthcare providers are steeling themselves for even more cases in the fall. The big worry is that a surge in cases will hit the health system just as flu season takes hold. In a recent interview, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC), warned that “the assault of the virus on our nation next winter [may] actually be even more difficult than the one we just went through… we’re going to have the flu epidemic and the coronavirus epidemic at the same time.”

Healthcare organizations are accustomed to
an influx of sick patients between October and March: around
62,000
people died and more than 700,000 were hospitalized during last
winter’s flu season. With 130,000
Americans
losing their lives to COVID-19 in just four months, what could
happen when the two respiratory diseases collide?

Large numbers of patients with either virus
(or potentially with both) will put renewed pressure on staff and services that
are already under immense strain. Hospitals will need to prepare to manage both
groups of patients as efficiently and safely as possible.

Five ways to ease stress, paperwork and
patient concerns ahead of a dual epidemic

1. Use data to drive your patient engagement strategy

Create a flu
preparedness patient engagement strategy
to keep patients informed of how
best to protect themselves in the context of a dual epidemic. As a result of
the coronavirus pandemic, patients may be more familiar with telehealth
services as a “contact-free” alternative to in-person appointments, so you’ll
want to continue to promote these to minimize the spread of infection.

With consumer
data
, you can segment patients according to risk and automate your
communications, so they get the most relevant message at the most convenient
time.

2. Relieve pressure on staff with automated patient scheduling

Digital scheduling gives
patients the option to book appointments online, at a time and place that suits
them. This reduces pressure on call center staff and can give providers control
over the volume and timing of in-person appointments, thus helping to reduce
the spread of germs.

An online
patient scheduling platform
can automate the entire scheduling process,
integrating in real-time with your records management systems and connecting to
your referral providers’ systems for a seamless patient and staff experience.

3. Screen patients proactively to discover their needs ahead of time

Asking patients to fill out electronic
questionnaires before their visit means their access needs can be identified
and addressed before they come in. Do they need help to find transportation?
Will they face any challenges in picking up a prescription? Is there something
that could stand in the way of follow-up care?

Screening for social
determinants of health
can answer these questions so you can
direct patients to the most appropriate care and support.

4. Enable digital patient registration for a quick and easy intake experience

Speed up the registration process by giving patients the option to complete their intake admin by phone or through their patient portal. Not only will this reduce the spread of infection in busy waiting rooms, it’ll make for a more enjoyable patient experience and free up limited staff resources for other priorities.

With automated
registration
and consumer-facing mobile
experiences, you can improve the patient experience, operational efficiencies
and data accuracy all at the same time.

5. Minimize in-person interactions with contactless payments

Encourage patients to clear their balances without
having to hand over cash or access payment kiosks. Self-service digital
payment tools
allow patients to make contactless
payments through their patient portal or from their mobile device.

It’s in line with consumer expectations, and
it could also increase patient collections: Saratoga Hospital
saw point-of-service collections increase by 50% after implementing more
user-friendly patient payment options.

“The combined pressure from two viruses hitting health systems at once means it’s even more important for providers to leverage data for speed and accuracy. Automated workflows can help accelerate operational efficiency, as well as create a better patient experience during what’s already an extremely stressful time.”

Karly Rowe, Vice President of Product Development for Experian Health

Find out more about how Experian Health’s expertise in data and analytics can help your organization prepare for the coming flu season so you can offer your patients a safe, accessible and stress-free experience.

We have also developed a checklist of action items for providers to consider as you prepare for both flu and COVID-19. How ready are you? Which actions is your organization instituting now?

The post Five keys to tackling flu season as it collides with COVID-19 appeared first on Healthcare Blog.

3 types of data providers should leverage to improve self-pay collections strategies

By
January 2021, millions of those who suffered job losses in the wake of COVID-19
will see their unemployment insurance end. Medicaid and subsidized coverage
under the Affordable Care Act (ACA) will be a safety net for many, but nearly 2 million Americans could find themselves stuck in the ‘coverage gap’, where
their household income exceeds the eligibility threshold for Medicaid, yet
falls below the lower limit required to receive ACA marketplace subsidies.

Without
large group or government coverage, these consumers will be left uninsured or forced
to purchase individual plans with high deductibles. Considering this will
likely contribute to larger patient balances and more struggles with patient collections, many are bracing for a hit to their bottom line.

To help minimize accounts receivable
and avoid bad debt write-offs, choosing the right data model should be a top
priority. Here, we look at one piece that’s often missing from the patient
collections puzzle: credit data.

Don’t
overlook credit data in your self-pay collections strategy

Many providers already use demographic and behavioral data to power patient collections, but there can be gaps in what’s known about a consumer’s ability to pay. Credit data can help fill in the blanks. Here are three ways this can be used to optimize your collections strategy:

1. Get a complete view of your patients’ financial situation for faster decision-making

Credit data can reveal how a patient is managing other
financial obligations, giving you insights about how to handle their healthcare
account for a greater chance of payment. Have they just maxed out a credit
card? Have they missed a student loan payment or fallen behind on their
mortgage? If so, they’re probably going to find it difficult to pay off their
medical bill. Knowing this, you can move quickly to help them find alternative
coverage or offer a more manageable payment plan.

Conversely, if they’ve just bought a new car or paid off a personal loan, there’s a high chance they’re in a good position to pay their medical bills too, so contacting them with a straightforward and easy payment plan means they can clear their balance promptly.

2. Segment patient accounts and allocate them to the right payment pathway

The sooner
you can get patients onto the right payment pathway, the more robust your
cashflow will be. Credit data can help you segment accounts quickly and
accurately. Experian Health data shows that when patients are segmented
according to propensity to pay, collections increase by around 2% when credit
data is included, compared to segmentation without credit data.

Martin Health System used Collections Optimization Manager to segment patients and check for available charity support or Medicaid eligibility. By getting patients on the right pathway and making sure agencies were focusing on the right accounts, they increased recovery rates by more than $3.1 million and identified an extra $975,000 in Medicaid coverage in just seven months.

3. Create a more compassionate patient financial experience

Using
credit data also helps create a more compassionate patient financial
experience. Instead of adding to a patient’s financial worries by chasing
payments they’ll never be able to cover, you can run charity checks to see if
there’s any missed coverage and quickly connect them to the right financial assistance program.

A tool such as Collections Optimization Manager lets you
segment patients based on their individual circumstances, for a more
patient-friendly approach to collections. You can then personalize their communications and payment
options so they can manage their expenses with less anxiety and more
confidence.

Discover why 60% of US hospitals are already using Experian Health’s advanced collections software and unrivaled datasets
to optimize patient collections, and find out how we can help you build a
resilient revenue cycle as self-pay accounts continue to rise.

The post 3 types of data providers should leverage to improve self-pay collections strategies appeared first on Healthcare Blog.

4 Ways to Make Patient Collections More Compassionate

Medical expenses are often a source of anxiety for many patients, whether they are unsure about the amount owed or how they’ll ultimately pay for it. Unfortunately, intimidating collections processes don’t help, and a crisis like COVID-19 only exacerbates this stress. A more compassionate billing approach could help patients better navigate their financial obligations and also build long-term loyalty—a necessity for providers today looking to retain patient volume during a time of crisis.

Consumers overwhelmingly want to understand the cost of healthcare services, prior to services being performed. Effectiveprice transparency involves offering patients clear, accessible, and easy-to-understand estimates of their financial responsibility for services before they are performed.

Give patients clarity from the start with precise pricing estimates and up-front info about what they’ll have to pay can reduce sticker shock, help them plan and create an overall better patient financial experience.

By empowering your patients with financial expectations, their feeling of control increases, improving their engagement and the likelihood that you will collect payments faster and more efficiently.

Just as you don’t provide identical medical treatment to every patient, processing all patient accounts the same way doesn’t make sense. Every patient is different.

Using comprehensive data and advanced analytics, providers can better understand an individual’s propensity to pay and make the payment process a positive one by assessing and assigning each patient to the appropriate financial pathway based on their unique financial situation.

Medical bills are often the most direct contact providers have with patients after a service is rendered. Unfortunately, money is often a sensitive topic for patients and statements are often overwhelming and difficult for patients to read.

Tailoring communications at each stage can convey compassion and increase patient satisfaction. Customizing patient statements gives providers the ability to simplify and customize bills quickly and easily, turning an often confusing process into one that adds value. Including relevant, personalized messages and educational updates can turn billing statements into a useful resource, all with the potential to drive revenue.

In addition to offering personalized payment options, providers can also find out whether a patient prefers to discuss billing by phone or email.

Minimizing friction at the point of payment is crucial to fostering compassionate collections.

Providers should offer flexible options that include in-person, telephone, mobile and online patient portals, so they can pay in a way that’s most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statement.

Want to learn more? Check out Experian Health’s Collections
Optimization Manager
which helps providers segment patients based on an
individual’s propensity to pay and payment preferences, informing a
compassionate patient engagement strategy and improving collections.

The post 4 Ways to Make Patient Collections More Compassionate appeared first on Healthcare Blog.

Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement

Patients
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
reimbursement?

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
    essential.
  • 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.

Schedule
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
Discovery
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
consuming.

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

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
Discovery
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.

The post Medicare MBI: COVID-19 and Medicare Claims 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
product.

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
checks

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
care
.

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.