All posts by Merideth Wilson
In the 1930s, Ovaltine offered listeners of the Little Orphan Annie radio program a membership badge with a decoder ring that allowed listeners to replace numbers with letters and figure out secret messages – which usually urged them to drink Ovaltine.. Fast forward to 2015, and a decoder ring can be bought online for under $20. Unfortunately, these trinkets aren’t sophisticated enough to help practices and hospitals decipher reimbursement contracts and identify underpayments. Providers today require robust analytics and automated workflows, coupled with a level of support that goes far beyond an instruction manual to include continual updates to contract terms by skilled contract analysts. According to the American Hospital Association, combined Medicare and Medicaid underpayments were $51 billion in 2013. Private payers further contribute to underpayments, totaling a hefty financial gap for providers, regardless of care setting. It is imperative that providers across hospitals and medical groups take proactive measures to ensure they are paid fully and fairly for the care and services delivered. Incorporating automated solutions enables providers to fully decode the hidden “catches” in contracts while recovering underpayments. Understand how proposed contracts with payers affect your revenues When a payer assures you that proposed contract changes will benefit your organization, are you skeptical? Using contract analysis and modeling, you can accurately predict how a change in any of the hundreds of variables in third-party contracts will affect reimbursement for your precise mix of services. Not only can contract analysis let you see the overall impact of an individual contract, it also lets you precisely model revenues so you can see the gains or losses for each individual specialty, provider or service. By assessing which factors have the greatest impact on your reimbursement, you can refine your bargaining strategy to negotiate better-performing contracts. Verify the accuracy of payment received from third-party payers Ensuring your contracts are as advantageous as possible is just half the battle; you still have to confirm that payments follow the guidelines of the contract. Complicating this process is the move to new reimbursement structures that bundle payments or base them on value rather than services. Verifying payment accuracy can easily bog down your team–unless you put the benefits of automation to work for you. Contract management and analysis solutions streamline workflow by auditing claims so you spend time only on those that require intervention. Through data-driven insight, you can conduct contract-based appeals and recover lost revenue. Together, these solutions assist in reviewing and modeling contracts, and then accurately identifying, appealing and recovering underpayments. With the ability to value the claims you file and evaluate overall contract performance, you decode the information locked away in data. All without a decoder ring. Don’t miss our upcoming webinar, \"Overcoming the Three Ps: Payers Who Pay Poorly” Featured Speakers: Kristen Prenger, Director of Managed Care, Lake Regional Health System Rebecca Charo, Product Director, Experian Health Date: Thursday, May 21, 2015 Time: 11 a.m. PT/1 p.m. CT/2 p.m. ET Register now!
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.\"
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.
With the rapidly changing healthcare environment, many organizations are taking a hard look at their revenue cycle, seeking proactive ways to enhance both efficiency and performance in the era of value-based care. While the need to improve is clear, the opportunities for improvement may be obscured by myth and misperception. For example, consider the following long-standing myths about patient payment that, if not set straight, could limit your organization’s ability to optimize the revenue cycle and enhance financial performance. MYTH #1: All patients are equally likely to pay. Reality: No two patients are alike, whether you’re looking at their medical conditions or their financial data. Assessing a patient’s likelihood to pay at the earliest point in the patient encounter can help you design your collections efforts to not only increase the probability of patient payment, but also foster greater patient satisfaction. By leveraging data and analytics to segment patients, you can realize a proactive and customized approach to collections that takes into consideration a patient’s unique financial situation and payment history, and tailors payment amounts and collections strategies accordingly. MYTH #2: It’s hard to have meaningful financial conversations on the front end. Reality: Contrary to popular belief, most patients are receptive to a financial conversation with their healthcare provider. Patient access staff can serve as the gatekeepers of the patient experience, engaging patients even before their time of service with personalized and informed financial discussions about patient responsibility and payment options. With this unique patient data at their fingertips, staff can also assist patients who may have trouble meeting their financial obligations, checking eligibility for internal and external financial assistance programs and automating the enrollment process. MYTH #3: It\'s impossible to know what patients owe across a system in one look-up. Reality: Organizations can once again turn to data and analytics, using it to aggregate prior balance information from across the healthcare system. This allows patient access staff to view comprehensive open balance data as part of the registration process and use scripts to guide compassionate financial conversations. Even if these fact-based discussions don’t lead to immediate payment, the additional reminder that a balance is due often prompts a patient to action, yielding faster payment. Dispelling these and other myths is simple when an organization uses tools that leverage both clinical and financial information to increase reimbursement in an era of value-based care. These proactive efforts result in less risk, increased collections and enhanced patient satisfaction. That’s a reality that every healthcare organization should experience! What myths are you debunking at your organization?
We encounter gatekeepers every day, ranging from TSA agents at the airport and call-center operators for online retailers to office receptionists and hotel front desk staff. Gatekeepers have a tough job as they manage access, filter information, provide advice and maintain order. Their attitude and actions dramatically impact our experience as consumers. The healthcare industry must shift from a patient focus to a consumer focus — and it all starts with patient access. Patient access staff act as the frontline — the gatekeepers — as they gather critical patient information at the start of the patient visit and set the stage for the remainder of the encounter. They’re moving beyond simply performing routine registration tasks and collecting co-payments to engaging in a holistic approach to patient interactions. As a result, these critical staff members can create and facilitate compassionate financial discussions while handling revenue-related activities such as pre-service collections. It’s no small task, nor one that can be done without data and analytics. For example, staff can use tools driven by data and analytics to verify patient identity, which prevents fraud and identity theft and results in more accurate registration. Moreover, after reviewing insurance eligibility, patient access staff can leverage data and analytics to create accurate patient payment estimates, review data to assess a patient’s ability to pay and evaluate financial options. The bottom line impact creates a positive environment for financial discussions and improves collections on the front end, while reducing the likelihood of collections calls and bad debt on the back end. Patients benefit in that they gain a sense of confidence — and oftentimes relief — because they know where they stand financially and can focus their energy and attention on getting well. The time is right to establish patient access staff as gatekeepers of the patient experience by equipping them with knowledge and tools to empower them to improve the revenue stream and patient satisfaction.
