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For many of the 36 million Americans who have registered for unemployment benefits during the coronavirus outbreak, losing their job means losing their health insurance. Options for the newly-unemployed are limited yet complicated: while the federal government has declined to reopen enrollment under the Affordable Care Act, several states are supporting those without coverage by opening emergency enrollment periods for state-based health exchanges. Those that can afford it may extend their existing employer plan through COBRA, while those that can’t may apply for Medicaid. But unfortunately, millions will be left without coverage. Now, with these changes happening in both large quantities and at rapid speed, the process for checking a patient’s coverage status is more complex, time-consuming and susceptible to errors than in normal circumstances. Further errors may appear as patients are forced to switch care teams, leading to disjointed care and incomplete, inaccurate or duplicate health records. It’s a huge administrative and financial burden for providers, who must keep pace with changes to the health insurance landscape or risk a surge in denied claims as a result of patient misidentification. How should they guard against patient identity errors and minimize revenue loss in the wake of COVID-19? How to prevent mismatched patient records and avoidable claims denials A 2018 survey found a third of denied healthcare claims were caused by patient identity errors, costing hospitals an average of $1.5 million. We may see this figure creep up following COVID-19, unless providers move quickly to implement robust identity proofing and patient matching processes. Providers looking to do this should consider prioritizing the following three areas: Eliminate errors during patient registration Up to half of denied claims occur earlier in the revenue cycle, which is also when most duplicate medical records are created. Improving identity proofing during patient scheduling and registration is a logical place to focus, to ensure records are accurate from the start. This should include proactively checking for active coverage as early as possible. Using a Coverage Discovery tool that automatically finds available coverage will help avoid bad debt write-offs and give patients peace of mind. Essentia Health’s Patient Access team were able to find 67% coverage pre-service, for patient accounts that were previously considered self-pay or uninsured. Automate identity matching throughout the revenue cycle When patient records are incomplete, duplicated or overlaid with part of someone else’s record, denied claims become an accepted cost – but they’re often avoidable. Instead of time-consuming and error-prone manual checks, providers should consider using automated identity management software to ensure patient records are accurate and complete. Data-driven matching technology supported by a Universal Patient Identifier allows a single view of each patient to be shared safely and securely across multiple healthcare services. There’s no need for tedious reconciliation work and providers can be confident they’re submitting clean claims each time. Improve identity management protocols for telehealth and mobile services More patients turning to telehealth services and patient portals to minimize face-to-face contact, putting pressure on providers to solve the patient matching problem. And with payers expanding coding for reimbursements for telehealth and remote services, there’s an added imperative to make sure patient information is accurate in order to minimize the risk of claims denials. Victoria Dames, Senior Product Director at Experian Health, says portal access has increased by roughly 40% since the start of the coronavirus outbreak, and explains that the rise in telehealth and mobile services means identity proofing must be a priority: “If you don’t already have identity proofing and automated solutions for patient matching in place, you’ll have duplicate records. We don’t want that – it’s important to have one view of the patient. But we need to move quickly. Automating for identity proofing eliminates the risk of human error and it’s faster too, which is crucial right now. We know many providers want to get their identity management and claims management systems optimized quickly, so we have a team set up to help.” Using the right technology to verify patient identities and analyze claims, avoidable denials resulting from missing or incorrect information can be caught sooner. Contact us to find out how we can help your organization manage patient identities to eliminate costly claims denials during and after COVID-19.

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: 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 term “digital front door” is one of the biggest buzz words in healthcare, and thanks to COVID-19, we can expect to see it even more. Already, according to an Accenture survey, 77 percent of patients believe the ability to book, cancel, or change an appointment online is important. Now, with social distancing and stay at home orders in place, offering digital tools for engagement is more important than ever. But what exactly makes a strong “digital front door” and what does it take to create one? What precisely does a digital strategy need in order to better engage and retain patients? There are a lot of thoughts about what the digital front door looks like, from pricing transparency to ratings and reviews, reputation management, patient registration, and more. We know patients today are seeking greater transparency from their entire healthcare experience. Yet each of the qualities above reflect more of a digital billboard than an actual front door. After all, the front door needs to be a pathway to see a physician or access care; it must actually “open.” A true digital front door will do the following: Enable omni-channel access. Improving access begins with offering more channels for patients to find the care they need – a necessity today in the midst of COVID-19. Digital scheduling drives patient access, plain and simple, whether it be through call centers, automated outreach, or online self-scheduling. Omni-channel access not only opens the door for patients experiencing COVID-19 symptoms, giving them a fast and easy way to connect with a provider, but will be key for the post-COVID world when patients begin to reschedule those appointments that have been cancelled or deferred. Engage patients. Patients want convenience when it comes to accessing care. Now, more than ever, patients look online for information and expect to find what they need easily and quickly. Making service information available online, such as COVID testing, is an obvious first step. Allowing consumers to simply and efficiently book the care they need online will lead to increased engagement, as well. Improve productivity. More than half of all patients prefer to schedule outside of business hours. Digital scheduling can enable that, increasing appointments while improving provider workflow, freeing up staff to focus on other activities. This will prove critical as providers brace for an influx of patients seeking to reschedule appointments that have since been cancelled or deferred due to COVID-19. Additionally, automated reminders help improve patient show rates while data-driven practices help refine scheduling logistics.  Increase revenue. Providing better, more efficient access, increases the number of patients coming into a practice – which means more revenue. And today, as a result of heroic efforts to serve communities impacted by COVID-19, providers are more strapped for revenue than ever before. With access to digital and mobile solutions, providers can attack revenue loss from two sides –attracting new patients and retaining current ones. Drive higher patient satisfaction. Faster, easier access to healthcare equals better satisfaction with the process of accessing healthcare, with the provider organization, and with the provider. And, if you really want a crowd pleaser that can also generate revenue, automated business rules and scheduling protocols are a must have.It’s the combination of convenience and effectiveness that keeps them coming back for future care needs – coming back, of course, through the digital front door. Learn more about how Patient Scheduling can help to unlock your organization’s digital front door.

There’s an identity matching challenge that’s existed in healthcare ever since the move to electronic medical records began, and the urgency to remedy it has been increased by the speed and danger posed by COVID-19. How do you identify a patient with limited information? How do you know what medical record or lab test to associate with a patient? Capturing complete or accurate patient demographic information is difficult and can be impacted by many factors far less chaotic than a pandemic. By any measure, under normal circumstances, hospital registration takes place in a fast-paced environment. “Normal” changed abruptly for the United States in March and the Office of Civil Rights (OCR) recognized the need to enable innovations that will help keep pace with the virus’ relentless pace. OCR announced in early April that it would exercise its enforcement discretion and not impose penalties against covered health care providers or their business associates for uses and disclosures of protected health information by business associates for public health and health oversight activities during the Covid-19 nationwide public health emergency. The COVID-19 Identity Challenge Pop-up and parking lot testing sites provide little opportunity for healthcare staff to follow typical patient intake processes or access the technology and tools used in their hospitals and medical offices for registration. Information is gathered with everything from pen and paper to tablet devices; however, these methods are challenged to collect a patient’s information while maintaining social distancing requirements. This often results in incomplete or inaccurate patient information, making patient follow-up near impossible – not knowing who to contact or where to contact them.   The number of positive COVID-19 cases continues to grow and public health officials at the federal, state, county, and local level have an urgent need to understand and describe how the virus is spreading, and effectively support impacted individuals. In accordance with OCR’s announcement, Experian Health will provide individuals who meet the public health authority definition free access to certain features of its Universal Identity Manager (UIM) product to assist with filling in missing patient demographics.  Any access to UIM services (and the PHI therein) is limited only to public health authorities and only until the Secretary of the Department of Health and Human Services declares the public health emergency no longer exists or upon the expiration date of the public health emergency1. For additional information on the UIM, please visit our website. This is a step that Experian Health is proud to take, playing our part in combatting the outbreak of Covid-19 and expediting the country’s path to recovery. 1. DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 160 and 164 Notification of Enforcement Discretion under HIPAA to Allow Uses and Disclosures of Protected Health Information by Business Associates for Public Health and Health Oversight Activities in Response to COVID-19 https://www.hhs.gov/sites/default/files/notification-enforcement-discretion-hipaa.pdf

A hundred years ago, the Spanish flu pandemic led to a revolution in public health. Healthcare systems were overhauled, national health surveys were launched, and cross-border cooperation laid the groundwork for what later became the World Health Organization. Now, with everything from grocery shopping to the global economy upended as a result of COVID-19, thoughts inevitably turn to the legacy of the current pandemic. As healthcare providers struggle to reorganize services, staffing and revenue cycles, change is being forced at a blistering pace. Adjusting is tough, but it’s also accelerating technology trends that healthcare has been slow to leverage until now. Could the coronavirus pandemic bring the future of healthcare to us sooner than expected, just like what happened in the years following 1918? What more can providers do to prepare for  challenges in the new normal? Here to stay: telehealth and virtual care Necessity drives innovation – and one key example now is the telehealth explosion. Only a few months ago, remote healthcare was a business choice, selected for being more cost-effective and more convenient for patients, and for reducing the service-load on busy physicians, compared to traditional face-to-face care. Today, it’s an operational essential in preventing the spread of the coronavirus, giving patients a safe way to speak to their doctor without leaving their homes. Relaxed regulations, clearer payment rules and a hundreds of millions of federal cash injection are giving the roll-out a helping hand. Not only is this promoting better patient care and mitigating some of the revenue loss from reduced patient visits, it’s giving providers an unexpected opportunity to conduct a large-scale experiment in the use of telemedicine that would otherwise have been impossible. And it’s working. Patients, physicians and providers are getting used to the benefits of virtual care. Telehealth and self-service patient engagement will likely become the norm once the pandemic settles. Future-proofing healthcare services for a post-pandemic world Even though COVID-19 is far from over, now is the time to plan ahead for managing the pandemic fallout and to protect against future risks. As leading trends forecaster Mary Meeker suggests in her coronavirus trends report, what we really need to prepare for the aftershocks of COVID-19 is better integration of healthcare and technology. We already have the tools at our fingertips – and telehealth is just the start. Where are the gaps? Improving contact tracing and syndromic surveillance The medical community highlights contact tracing as essential for getting a handle on the spread of the coronavirus and potential future outbreaks. Unfortunately, we don’t yet have a system of universal patient identification, which could aid disease tracking by monitoring patient interactions with different touchpoints across multiple health services and generally aiding more accurate patient records. Still, many providers are turning to universal identity managers to track healthcare interactions and share accurate patient information safely and securely within their own networks. Prioritizing data protection and security With the surge in remote care and mobile health, keeping patient data safe through robust identity protection and matching is even more important. A tool such as Precise ID can give providers reassurance that only patients engage with  their information – whether on their phones or visiting a provider’s health portal – without  creating long wait times or adding complexity to the sign-up process. Strengthening the revenue cycle Estimates suggest health systems could lose an average of $2,800 per COVID-19 case, with many losing up to $10,000, if payers do not raise reimbursement premiums. Ceasing revenue-generating services to accommodate COVID-19 cases only compounds the financial strain on the healthcare system. With revenue cycles at breaking point, there is no room for inaccurate coding or claim denials. To help hospitals and healthcare organizations stay on top of rapidly changing payer policies, Experian Health is offering free access to COVID-19 and telehealth payer policy alerts, so providers can avoid delayed payments and costly claim denials. While the 1918 pandemic led to a complete revolution in our understanding of public health, the legacy of this virus may be more of an evolution – accelerating technological progress already moving forward. The organizations that adapt the quickest to the new normal will be most likely to survive. Find out more about the free resources and support available through Experian Health’s COVID-19 Resource Center to help your organization tackled the most pressing COVID-19 concerns. 

There is no doubt the healthcare industry has taken a financial beating as a result of COVID-19. But there is a glimmer of hope for providers. Several new announcements were recently made attached to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, specifically around reimbursements attached to COVID care for the uninsured. The financial stimulus, intended to stabilize hospital finances as providers face short-term revenue reductions due to the cessation of non-urgent procedures and the increased costs for personal protective equipment, has earmarked  a portion of the $100B established for CARES to reimburse healthcare providers at Medicare rates for the treatment of uninsured COVID patients. The guidance does not indicate specifically how much money will be set aside to reimburse these claims. The big question? How long will the funds last and how quickly will providers act? With both unemployment, translating into more uninsured individuals, and COVID cases on the rise, the dollars could be exhausted quickly. A recent study by Kaiser estimates the total payments to hospitals for treating uninsured patients under the Trump administration policy would range from $13.9B to $41.8B. While Medicare payments are about half of what private insurers pay on average for the same diagnoses, estimates surrounding COVID care can be in excess of $50k for those severe cases where struggling patients spend weeks in the intensive care unit on a ventilator. Bottom line, it’s likely the funds will be distributed quickly, especially when factoring in unemployment skyrocketing. As of April 30, more than 30M Americans have filed jobless claims amid the coronavirus outbreak. The all-new portal opened on April 27 for sign-ups, and providers can begin submitting claims electronically on May 6. Healthcare providers who have conducted COVID-19 testing of uninsured individuals or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020 can request claims reimbursement through the program electronically and will be reimbursed at Medicare rates, subject to available funding. A complete list of FAQs regarding the CARES Act and reimbursements are accessible on the Health Resources & Services Administration website. But what other tips and considerations should providers contemplate as they attempt to get their fair share? Here are three actions to optimize a provider’s chances of claiming reimbursements for the uninsured. Automate the insurance check. Providers must attest that they have checked for healthcare coverage eligibility and confirm the patient is uninsured. If they fail to check, they may be denied. Providers must verify that the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, or any other payer options that will reimburse for the COVID-19 testing and/or care of that patient. There are ways to automate this step, completing a second eligibility check to attest that the patients have no coverage before providers submit claims to the government. Scan for the social security number (SSN), if possible. While there may be instances where COVID patients entered a facility and were quickly admitted with no formal registration process, the CARES Act states an SSN and state of residence, or state identification/driver’s license is needed to verify patient eligibility. If these pieces of information are not captured, providers need to attest that they have attempted to capture this information before submitting a claim. The patient may be long gone, but there are still ways to attempt to retrieve a patient’s SSN after they have exited the healthcare facility. Providers should know that claims submitted without an SSN and state of residence, or state identification/driver’s license may take longer to verify for patient eligibility. Again, with the possibility that these funds could quickly be exhausted, it is in the provider’s best interest to submit claims that are as clean and validated as possible. Act fast. Recall the Small Business Administration’s Paycheck Protection Program (PPP) — a coronavirus relief fund for small businesses that was also established under CARES? The $350B allocated by the bill was quickly depleted in days. While these funds were going to individuals in entirely different industries, there is no concrete projections on how long healthcare providers can expect the $1B fund to cover reimbursements for the uninsured. So, providers need to act now, and fast, by tapping into automation and auditing solutions that will optimize their chances of securing their fair share.