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“With Coverage Discovery, Luminis Health can now find more billable coverage, whether primary, secondary, Medicare or Medicaid. Luminis can follow up immediately with payers when there is no initial real-time eligibility response available. Not only does this improve financial performance, but it also reduces manual work and minimizes errors before claims are filed.” Sheldon Pink, Vice President of Revenue Cycle at Luminis Health Challenge Luminis Health is a not-for-profit health system with an annual revenue of $1.2 billion and over 9000 employees. As one of the top three hospitals in Maryland (according to the U. S. News and World Report), Luminis’ vision is to break down barriers to health and deliver more high-quality care across the region. Finding and verifying insurance coverage for more self-pay patients was contributing to Luminis Health’s levels of bad debt. Staff relied on manual processes that were time-consuming and inefficient, and a vendor solution that did not integrate with Epic®. Limited productivity led to delays, denials and compromised patient experiences. To resolve these challenges, the organization’s goals were to: Create a positive patient financial experience by providing accurate and quick patient financial estimates Reduce bad debt by finding accurate primary and secondary insurance coverage Eliminate manual processes for following up real-time eligibility (RTE) responses with payers Reduce the number of self-pay patient accounts that end up in bad debt Solution With Coverage Discovery, Luminis was able to maximize reimbursement, reduce bad debt and improve the patient experience. Coverage Discovery finds additional active coverage that patients may have forgotten about. Using verified patient information, proprietary databases and confidence scoring, the tool scans for active coverage across the entire patient journey. This means no financial stone is left unturned before the patient is billed directly. By identifying coverage that would otherwise have been missed, Luminis can avoid misclassifying patients as self-pay, and prevent accounts from being incorrectly sent to bad debt or charity. Staff can focus on accounts most likely to be rebillable to insurance, rather than wasting time on avoidable manual rework. In certain instances when patients do not know they have secondary coverage, Coverage Discovery: Verifies patient demographics to ensure patient details are correct Leverages a range of proprietary databases (including Employer Group mapping) and historical patient search information to find insurance that may have been used and verified at other locations Applies a confidence scoring system to reduce the noise and eliminate “false positives,” so the client doesn’t waste time reviewing incorrect information or irrelevant coverage Outcome As a result of using Coverage Discovery, Luminis found more than $240k in active coverage on average per month in 2021. They reduced the number of self-pay patient accounts ending up in bad debt and created positive patient financial experiences by minimizing patients’ financial obligations. Reducing reliance on manual processes also led to fewer real-time eligibility responses from payers. Sheldon Pink reports that implementation was straightforward, thanks to Coverage Discovery integrating seamlessly with Epic® and support from the Experian Health team: “We’re impressed with these results and with the partnership with Experian Health. Luminis is looking forward to building on this success and continuing to collaborate with the Experian Health team.” Find out more about how Coverage Discovery helps healthcare organizations find missing and forgotten coverage, to improve financial performance and contribute to a better patient experience.

Matt Hanas, Lead Product Manager at Experian Health, shares how providers can improve collections amidst staff shortages and decreased patient volumes.

The State of Patient Access 2023 survey looks at ongoing trends, challenges and opportunities for improvement when it comes to patient access.

Learn how utilizing artificial intelligence for claims management can help healthcare providers predict and prevent denials.

Finding insurance coverage can be complicated, especially in an already complex reimbursement landscape. That’s where Coverage Discovery can help. 

Proactive price transparency could be a competitive advantage for healthcare providers, as a Kaiser Family Foundation survey suggests a majority of Americans believe Congress should prioritize the issue. The survey revealed that 60% of respondents think legislative action to make healthcare prices more transparent should be a “top priority” for the next Congress, while a further 35% said such laws were “important, but not a top priority.” Concerns about the cost of living are top of mind for many households, with 91% of respondents specifically noting their worries about rising healthcare prices. Providers can help meet the demand for more transparent pricing by implementing solutions to make it easier for patients to understand and plan for upcoming bills. Those that proactively meet and exceed patient demand for clearer pricing information will garner more patient trust and loyalty, and in turn, secure an important competitive advantage in a challenging economic context. Why are patients calling for greater price transparency? For many patients, the process of paying for healthcare is like trying to find their way through a maze, with numerous twists and turns and no clear path forward. Unlike most other purchasing decisions, patients lack upfront information about the options in front of them. Many do not fully understand the cost of care, and as a result, may not be aware of or prepared for the forthcoming financial burden. This lack of transparency causes uncertainty and unease, leading to postponed care or missed payments. With transparent pricing, patients can make more informed decisions and choose the most cost-effective options. Those with high out-of-pocket expenses can shop around for services that best fit their budget and estimate the cost of care in advance. Transparent pricing is especially important for patients with chronic conditions or those who require ongoing care. Are providers meeting the demand for price transparency? Many providers have embraced the push for transparent pricing, by introducing upfront patient estimates and tools to help patients understand and manage their bills. Transparency may be a requirement under the Hospital Price Transparency Final Rule, but providers are also incentivized by the promise of faster payments and fewer time-consuming billing queries. However, implementation of price transparency measures has been patchy: as of August 10, 202, only 16% of hospitals were compliant with the rule. In a podcast interview for Becker’s Hospital Review with Riley Matthews, Lead Product Manager at Experian Health, Jamie Cleverley, President of Cleverley + Associates, suggests two main obstacles: confusion around what information needs to be disclosed (more on this below) concerns that sharing pricing information could negatively affect revenue. The second concern is valid, but evidence suggests that disclosing prices to patients can save money, by reducing unnecessary hospitalizations, readmissions and emergency visits. Missed payments are less likely if patients feel in control of their financial situation. In fact, research by Experian Health and PYMNTS suggests that upfront cost estimates improve patient satisfaction by 88%, which encourages prompter payments. Delivering a better patient experience with accessible pricing information To help healthcare organizations meet patient demands for clearer pricing and ensure compliance with the federal rule, Experian Health and Cleverley + Associates have teamed up to provide a standardized solution. Listen in as Jamie Cleverley, President of Cleverley + Associates, and Riley Matthews, Lead Product Manager at Experian Health, discuss how a new partnership is helping providers comply with the Price Transparency Rule: Each organization brings its specific expertise to help healthcare providers provide clear and compliant pricing information: Experian Health’s Self-Service Patient Estimates tool enables compliance with the requirement to display payer-specific rates as a consumer-friendly list of 300 shoppable items. This tool gives patients upfront, accurate estimates that are easy to understand so that they can make informed choices about their care. Cleverley + Associates helps providers make pricing information available as a machine-readable file, quickly and at scale, so providers can fulfill the requirement to display such files on their website. The solution is neatly packaged to save providers from engaging in discussions with multiple vendors or scrambling to find internal solutions for each individual requirement. Cleverley says that working with the two organizations together can save providers time and stress: “We have the information and the technical capacity to offer a format we think is useful, which complies with all the rules. There’s anxiety around this – providers worry about whether CMS will view [their solutions] as compliant. But with us, they’re working with trusted partners that have had those conversations with CMS, that have released these files already and that have been through the audit process.” For Matthews, this adds up to a user-friendly experience that’s not only compliant but gives patients what they need: “We needed to provide a patient-facing estimate-creating solution that shows those top 300 shoppable services for a hospital or a doctor’s office. We were able to do that through our existing product, Self-Service Patient Estimates. We have this portal that we can integrate with our clients’ websites, which guides patients through the entire process. What we did not have – and where Cleverley came in – were those complex machine-readable files… So, we were able to come in from both sides with price transparency and say, ‘ok, now we solve both, and we’re here to provide a holistic solution.’” From compliance to competitive advantage Penalties for non-compliance with the Price Transparency Rule may have been limited to date, but this may change as the rule reaches its second anniversary. Furthermore, some states are starting to bring in their own legislative measures to protect patients from opaque billing practices. And with patient expectations clearly stated, the pressure on providers to deliver transparency is mounting. But as noted, this is about more than compliance. Patients are looking for a clear and compassionate financial experience and will reward providers that deliver this. Providers should consider how to keep patients informed and empowered at every stage of the financial journey. Experian Health offers a suite of payment tools designed to achieve this, which bring together accurate estimates, tailored payment plan recommendations and convenient payment options. Find out more about Experian Health’s Price Transparency Solutions or watch the video to hear more about Experian Health’s price transparency partnership with Cleverley + Associates.