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    Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage — vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements?   Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage

You may also like: Supercharge your COVID-19 vaccine management plan with digital solutions “Experian Health’s ability to move quickly and adapt their self-service platform to schedule vaccines for patients has been an invaluable improvement not only for our operations, but to the patient experience. The power to schedule the vaccine’s second dose after the first is administered helps us deliver on our commitment to providing reliable, quality care.” – Julie Frahm, director of consumer digital products at Sharp HealthCare The unpredictable nature of patient volume is a large part of what makes scheduling for the COVID-19 vaccine so difficult. Before now, providers haven’t had to manage mass appointment slots and registrations tied specifically to vaccinations. And even with those features streamlined, providers are still unsure of the best way to reach out to patients who are eligible for the vaccine to prompt them to schedule their appointment. Already a user of Experian Health’s Patient Schedule solution, Sharp HealthCare turned to online self-scheduling to improve patient access to the COVID-19 vaccine. With the solution in place, patients of Sharp HealthCare who are eligible for the vaccine can schedule their first dose online via computer or mobile phone. After answering a short set of questions, the scheduling solution will guide patients to a calendar of available day and time slots for receiving the first vaccination. After the first shot is administered, Sharp HealthCare staff can schedule patients for their second dose onsite, prior to leaving the office. Patients of Sharp HealthCare are consistently utilizing online self-scheduling to book appointments for their vaccinations. More than 1,000 vaccinations were scheduled in the first three weeks of online self-scheduling being available to patients. The ability for provider staff to help book the second dose of the vaccine for patients has also helped Sharp HealthCare deliver on their commitment to quality care, further ensuring the efficacy of the vaccine for each and every patient. Patients are also enjoying the expanded use of a self-service digital service, especially for a process that has been widely known to, at least thus far, be a detriment to the patient experience. Discover how Patient Schedule can improve vaccine management.

Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation As the vaccine management process continues to ramp up, providers are focused on how to administer the vaccine to as many people as quickly and efficiently as possible. While certain features like online self-scheduling have helped to speed this process up, especially for those locations that are servicing thousands of patients per day, there are portions of the intake process that are being left behind that will consequently cost providers in the end. We interviewed Dustin Whittier, senior director of product management at Experian Health, about how providers can increase reimbursements for both the vaccine itself and the administration of the vaccine.  How will the volume of patient traffic and offsite administration of the vaccine challenge the reimbursement process? What we’re seeing, particularly at some of these large-scale roll outs, is the entire registration process being stripped. With so many individuals presenting at once for the vaccine, on site staff have significantly less time than usual to collect patient information such as insurance. Many are focused on capturing the bare necessity to quickly and efficiently serve patients. Some are even choosing to forego collecting insurance entirely. Obviously, rushing through the eligibility and insurance process, or bypassing the process itself, will have an impact on a provider’s ability to submit for reimbursement. The ability to confirm identify insurance after the fact may be feasible for a small number of patients, but at this volume, it is nearly impossible. Think of the volume a major vaccine pop-up site might see in a single day, maybe upwards of 20,000 patients. Imagine having a backlog of 20,000 patients to identify and confirm insurance for. It’s a nightmare. What can be done to mitigate these issues? A tool like Coverage Discovery automatically finds available coverage that was previously unknown or forgotten, whether Medicare, Medicaid or commercial insurance. Scans for coverage can be done in bulk, before or after services are rendered, helping providers better identify insurance for patients receiving vaccines. Providers are not only paid faster but can also avoid the collections challenges of self-pay receivables. Watch our interview with Dustin below: Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?

Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions The patient portal can play an important role in COVID-19 vaccination efforts, allowing patients the ability to both schedule their vaccines and keep track of where they are in the process, at least for those vaccines that require more than one dose. We interviewed Victoria Dames, senior director of product management at Experian Health, about how providers can authenticate portal access with automation, while also protecting patient identities. As portal traffic increases, what are the authorization concerns? Many providers who are supporting the mass vaccination sites are leveraging their existing patient portals to schedule patients for the vaccine. As providers are now seeing individuals sign up for portals at scale it can difficult to ensure that the individuals being granted access to the portal are in fact who they say they are. That is a huge concern knowing the patient portal contains PHI that is commonly a target for fraudsters. What are the benefits of automating portal enrollment and access? Automation alleviates two things. First, it provides an industry-wide level of security and assurance. It provides the market standard for identity proofing before granting access to a patient record. Second, it alleviates a lot of the administrative burden put on provider staff. Automating portal enrollment allows staff to focus their attention on other, more important efforts. And, for portal enrollment at this magnitude, automation really is necessary. Providers are seeing individuals going back multiple times to the same portal, signing in more than once and sometimes with multiple log-ins, just to schedule an appointment for a vaccination. Our recent survey on patient access found that 54% of patients are concerned about security when accessing their personal details online. From a provider’s perspective, does having a system like this help with the objective of making patients feel more secure? One area where patient and provider views align is around the security of digital access solutions. The balance, though, between security and convenience can be a tough one to maintain. Moving quickly while maintaining security – and without adding undue friction – is a tall order, but it’s not optional. With the right tools and support, providers can safeguard patient data throughout the vaccination process with confidence and make the portal enrollment process as frictionless as possible. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?

Take a poll of any healthcare facility’s visitors, and the majority will tell you they’d like to book appointments online. When Experian Health surveyed more than 860 consumers in late 2020 for its patient access trends survey, 78% of those surveyed said they wanted to schedule their own appointments, at any time of day or night, from their home or mobile device. But with only four in ten providers offering self-scheduling as a service, there’s a big opportunity for providers who offer digital patient access to attract and retain more patients by giving them what they want. Online self-scheduling allows patients to choose when and where they make their appointment. It is easier for patients, reduces no-shows, improves health outcomes and minimizes the risk of errors that can result in denied claims. But while online self-scheduling is meant to foster a better patient experience, not every solution is up to scratch. Providers need to offer an online scheduling experience that is user-friendly, reliable and accessible in order to create the best possible digital experience for both new and existing consumers. Patient portals can be a great location for existing patients to schedule appointments online, but what about new patients? Without an existing relationship or log in, new patients will likely click away from online scheduling services that require them to set up a new account or request a call. Unnecessary friction makes it harder to attract new patients. Given that 80% of patients would switch providers for convenience factors alone, offering online scheduling to brand new patients without requiring the additional step of creating an account could be a powerful attraction strategy. With manual scheduling, call center agents have to sift through multiple spreadsheets and binders to check calendars and scheduling rules in order to match patients with the right provider and appointment type. With a system like that in place it can be impossible to place more than a few patients each day. Patients that don’t want to wait or participate in lengthy calls often end up looking for care elsewhere. But if the right questions are guiding the online scheduling process, patients can be matched quickly to the right provider and book an appointment that fits with the provider’s calendar and scheduling rules. Adding a web-based scheduling service with guided search allowed Heritage Medical Associates to increase the number of patients placed from as few as three per day to as many as fifty per day, creating a better experience for patients, call center staff and physicians. Consumers want to schedule medical appointments the way they might book dinner reservation or a grocery delivery slot: they want to see all the available options for their preferred day, book on the spot and receive confirmation right there and then. They want to complete the scheduling process in real time – not waiting for a call back to confirm. CareMount Medical implemented an online scheduling platform to give patients real-time access to book appointments across all of their providers, which has appealed to both new and existing patients. Chief Information Officer, Nicholas Korchinski, says: “Yes, we have been able to acquire new patients, but our strategy was really about retention… Month over month we see double digit growth in use of the application, so our patients are benefiting more and more.” The ideal online scheduling platform will be flexible, accessible, and easy to use for both patients and staff. With Patient Schedule, providers can improve the patient experience, attract new patients and guide patients to the right provider without delay.

Providers know they need to improve their digital front door to withstand the financial impact of COVID-19, but change can feel risky, especially with so much uncertainty. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. But what do providers see for the future of patient access? And are those views aligned? Providers that offer the most accessible patient access solutions in a post-pandemic world will secure greater patient satisfaction and loyalty.