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It’s only natural to want to be fairly, fully and quickly reimbursed for services – it’s the basic foundation of business. Yet only in healthcare does attaining this basic transactional norm become challenging. Healthcare providers must be vigilant at all stages in the revenue cycle to ensure the amount they receive is timely and accurate. Achieving this deceptively simple goal is dependent upon insight – the ability to discern the true nature of a situation and to respond appropriately. Applying insight at critical points in the claims lifecycle can make a marked difference in reducing denials and accelerating payment.  The foundation of a successful claims management strategy begins with contract management, where advanced analytics and data-driven insight can help you quickly and easily pinpoint payment variances and validate reimbursement accuracy for each of your third-party payers. Ensuring compliance with contract terms allows you to identify recurring issues so they can be promptly addressed, while providing the ability to strategically evaluate overall contract performance. Once you achieve visibility of the contract process, you can apply those findings to other areas, such as claim scrubbing. Boosting the first-time pass through rate eliminates costly, time-consuming rework and speeds reimbursement. A strong claims scrubbing approach involves taking time, prior to submission to the appropriate payer or clearinghouse, to ensure the claim is complete, accurate and meets individual payer requirements. Once the claim is submitted, it’s not a matter of “out of sight, out of mind.” Tracking claim status early in the adjudication process – rather than waiting for a denial to appear on your desk – helps improve cash flow and maintain a healthy revenue cycle. An online payer portal provides instant insight into the status of each claim and gives you the ability to determine if a claim is lost, denied, pending or being returned. Regardless of how well you scrub claims before submission, it’s likely that a certain percentage will be denied. You can optimize and accelerate payments by quickly and efficiently identifying denied claims for analysis and re-submission. Use technology to ensure denied claims aren’t overlooked and streamline the workflow associated with claims management. Finally, taking a comprehensive look at all pending claims and denials allows you to prioritize claims and denials so that your staff can work the highest impact accounts first to improve efficiency and increase revenues.  Advanced technology that provides insight into contracts, payer requirements, claims status and denials holds the key to reducing the claims processing errors that add an estimated $1.5 billion in unnecessary administrative costs to the nation’s health system. Few healthcare organizations can afford to receive less than their fair reimbursement for the care they provide. By implementing a strategic approach that grants insight into each component of the process, healthcare organizations can bolster the bottom line and streamline efficiencies along the way. To learn more about how to turn these strategies into tangible results, register for our Dec. 3 Webinar, “5 Ways to Accelerate Your Claims Payments."

There’s a unique dichotomy in healthcare that’s not found in other service industries. For example, when you go out to eat at a restaurant, you don’t expect the server to ask you to pay before the meal is served. Conversely, you also don’t expect to walk out of the restaurant after the meal without paying. However, if you have ever ordered the special of the day and been shocked when the check arrives and the item costs twice as much as other menu items, you can certainly understand the patient’s viewpoint. How can a patient make informed choices about his or her healthcare without knowing the cost? Price transparency – one of today’s hottest healthcare topics – offers significant benefits to both providers and patients, including: Empowering the patient to make well-informed decisions on healthcare treatments Improving patient satisfaction and involvement with their care management Allowing appropriate upfront collections based on realistic estimates Serving as a foundation for establishing payment plans or seeking charity The difficulty of providing a reliable estimate has hindered efforts to collect from patients at the point of service, when they are most likely to pay. In order for the estimate to be relevant and timely, it must bring together financial data from the chargemaster, claims history and payer contract terms, and integrate that with the patient’s insurance benefits. Thankfully, this is a task that is ideally suited to technology. Not only can you use a payment estimator to quickly and easily create a targeted estimate, healthcare organizations can also eliminate the need to manually update price lists, as well as remove guesswork and tedious searches through potentially outdated patient information. An estimator is the base of an effective upfront collections strategy, and is complemented by the ability to determine if a patient is eligible for charity care in addition to their propensity to pay. An additional complement is to streamline the payment process by facilitating the collection of patient open balances through eChecking, signature debit, credit, recurring billing, cash, check or money orders. The ability to create price transparency that is applicable to each patient’s individual situation is critical to a healthcare organization’s financial performance.

Real-time information and advanced data and analytics help identify the most effective collections approach based upon each patient’s financial situation

Meet Joe—a patient who is walking into a healthcare office, terrified of the news he might hear. He is confused and overwhelmed, not sure of where to turn for help. Joe isn’t entering a doctor’s exam room – he is actually walking into a hospital’s patient registration area, waiting to receive information about how much his procedure is going to cost. Although anxious about the procedure, Joe is even more concerned about its impact on the family budget, unsure of his insurance co-payment or what will be covered. He’s worried that he can’t afford to pay a large bill in one payment. His interactions with the registration staff over the next few minutes will set the stage for the remainder of his experience with the hospital. Now, let’s say the hospital realizes the value of having caring and compassionate financial conversations with patients at the start of the patient visit. Patient access staff quickly become the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. In this instance, leveraging a data-driven approach allows staff to verify Joe’s identity and insurance coverage as well as provide an accurate estimate of his payment responsibility. The staff even can review data to assess his ability to pay and evaluate various payment plan and/or financial assistance options. Even after Joe is discharged, the hospital continues to employ a patient-centered approach to collections, using patient financial data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. Joe’s financial data places his in the “most likely to pay” segment, indicating that he would not receive a payment follow up call until (for example) day 75 instead of the traditional call on day 45. This not only saves staff time and increases successful collections, it also preserves Joe’s satisfaction by eliminating unnecessary phone calls when he is likely to pay. Joe expected the hospital’s clinical staff to be responsive to his medical needs. When he found that the revenue cycle team was equally attentive to his financial needs, his satisfaction with the entire experience grew exponentially. It was fueled by a positive encounter that eased his mind about payment and allowed his to focus on his health. Using this proactive, personalized approach, the revenue cycle team had a major impact on both Joe’s experience and the bottom line. What is your healthcare organization doing to enhance the patient experience? Comment below to share some of your best practices.

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There aren’t too many situations in which an individual purchases a product or service, but is NOT asked to pay for it right away. Healthcare, however, is somewhat unique in that regard, often avoiding a retail-based experience where patients receive service, but pay quite some time later, whether in full or the balance. Not surprisingly, this approach often times adversely impacts healthcare organizations in many ways. Best-case scenario, patient payments, while unpredictable, are received, but not in a timely manner and after a good deal of effort on the collections staff’s part. Worst-case scenario, the organization is left holding the proverbial bag, forced to write off bad debt, when payment could have been received if handled differently. In between, there are poor cash collections, increased revenue cycle costs and lower patient satisfaction. Organizations can avoid this perfect storm with a more precise approach to optimizing patient revenue. By leveraging tools that empower and improve upfront financial counseling communication, healthcare organizations stay one step ahead by accurately predicting patient responsibility payments and enhancing pre-service collections. When fueled by data and analytics, these tools offer a powerful two-pronged approach to minimizing risk and driving revenue: Avoid patient payment delays. Without knowing what insurance companies allow, many providers postpone collections until payer reimbursement is received. Healthcare organizations should instead have access to the latest contract terms, payment rules and fee schedules in order to identify patient and payer responsibility much earlier in the revenue cycle. Increase time-of-service collections. By proactively using patient payment data and current payer contract terms to calculate the amount owed by the patient at the time of service, organizations can effectively collect either a portion or all of that payment upfront. In the end, data-driven estimates of patient payment responsibility allow healthcare organizations to capture more revenue at the right time and boost cash flow. An added bonus is enhanced patient satisfaction because there are no confusing bills or ongoing collections calls, enabling a more personal experience for the patient. Hospitals have an opportunity to use data and analytics to improve the revenue stream and patient satisfaction. Learn about how Experian Healthcare Patient Responsibility Pricer can improve your collections on the front end of the revenue cycle and enhance the overall the patient experience.