All posts by Experian Health
Why is missing coverage so detrimental? When patients are unable to pay, providers see an increase in self-pay receivables - 97% of hospitals reported an increase in self-pay receivables compared with the prior fiscal year. When providers can’t collect, the result is uncompensated care $35.7 billion – The amount of uncompensated care hospitals provided in 2015 (AHA, Dec 2016, http://www.aha.org/content/15/uncompensatedcarefactsheet.pdf) Registration errors and frequently changing insurance coverage contribute to an increase in self-pay receivables and bad debt: 20% error rate: Wastes an estimated $15.5B in claims that are never corrected and re-processed. Find previously unidentified coverage to reduce bad debt Experian Health’s Coverage Discovery® solution provides an efficient and trusted means for healthcare providers to reduce misclassified self-pay accounts. Our advanced self-pay engine maximizes the actionable coverage found for our customers across government and commercial payers, previously missed due to frequently changing insurances, data entry mistakes or patient misrepresentation to avoid high deductible health plans. The benefits to you: Make coverage identification more efficient Reduce number of accounts sent to collections & charity Maximize insurance reimbursement revenue Identify primary, secondary, & tertiary coverage Automate the self-pay scrubbing process What are our clients are saying about Coverage Discovery: [Video] Murry Ford, Grady Health System: “Coverage Discovery has brought in quite a bit of revenue for us—revenue that we would not have identified otherwise.” [Video] Mike Simms, Cone Health: “Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments—more than a 300% ROI. It’s well worth every dollar spent.” Here’s why Coverage Discovery is different: Flexibility: Multiple delivery options easily fit Coverage Discovery into your revenue cycle Time matters: Find coverage on-demand Powered by Experian: Billions of data assets improve account specific intelligence and maximize found coverage Relevant: Confidence Scoring reduces data noise and removes potential false-positives to ensure staff time is focused on actionable accounts Uncover previously unidentified coverage with Coverage Discovery.
Challenge: a disconnected healthcare ecosystem Exchanging information across the healthcare ecosystem and achieving interoperability is a goal and challenge all healthcare organizations share. While regulations such as the Affordable Care Act introduced incentives and requirements to drive adoption of electronic medical records, they also highlighted a critical gap in healthcare – a universal patient identifier. Impact: Felt downstream across your enterprise The lack of a universal patient identifier, compounded by data integration challenges and the increasing fluidity of patient data, has created significant issues downstream – billing errors, redundant treatments and testing, HIPAA breaches, incorrect administration of treatments and prescriptions, and more. These issues contribute to the pool of preventable medical errors, which is currently the number three leading cause of death in the United States. Solution: Universal Identity Manager Experian Health’s Universal Identity Manager (UIM) accurately identifies patients and matches records within and across disparate healthcare entities, creating a universal patient identifier to facilitate information exchange. Drawing on more than 40 years of experience managing universal identifiers across various industries and leveraging Experian’s consumer demographic information, the UIM achieves higher match rates than traditional industry solutions. Integration flexibility The UIM is integrated within eCare NEXT®, but also supports various API options. It can also be leveraged in conjunction with biometric and traditional Enterprise Master Patient Index solutions. Batch: Receives, processes, and loads patient demographic information via patient data file. Starting with an initial historical patient data file in batch is recommended. The UIM algorithm is applied to accurately identify duplicate records and assign a Universal Patient Identifier (UPI) that can be used to facilitate information exchange across different healthcare entities. The UIM Batch is currently being offered at no charge to the entire healthcare industry. Duplicate Merge Tool: Provides a workflow tool to address duplicate patient records identified through the UIM batch. The Duplicate Merge Tool encompasses robust access and issue assignment management, configurable merge strategies, customizable search and filter capabilities, comprehensive audit trails, and postback or file output options. Search & Duplicate Medical Record Number (MRN) Alert: Leverages in process scripting to perform a real-time search the UIM as patient demographic information is being entered into an HIS during registration. The optimized patient record for each potential patient match is returned. If the search is circumvented, a Duplicate MRN alert will be created within eCare NEXT and prompt manual user review. Real-time search can also be facilitated through a direct API integration. Experian Single Best Record: Leverages an algorithm to look across all linked patient accounts that exist within a client’s enterprise database and aliases and addresses from Experian’s demographic information and returns back a patient’s single best record by demographic field. Data Analysis: Offers standard, premium, and custom reporting options with detailed data analysis across your patient data file. Learn more about Universal Identity Manager here, or contact your account representative for more information.
Sanford Health vetted four revenue cycle vendors to meet their challenges of manual collection processes, bad debt and low employee collection rates. They selected Experian Health largely based on ease of implementation with the Epic platform, products that required little intervention from Sanford’s IT department, a strong team of consulting resources and previous success with other Experian Health products. According to Mike Beyer, Director Patient Accounts, Sanford Health, “Collections Optimization Manager really allows me to segment out and find those patients that have the ability to pay; and to avoid chasing those who instead qualify for our Presumptive Financial Assistance/Charity program.” With Collections Optimization Manager, Sanford Health realized a total in-house patient collection lift of $40+ million since they first implemented in October 2014; with an average monthly lift is $2.3 million. Contributing drivers of this success: leveraging segmentation and Federal Poverty Level (FPL) within Collections Optimization Manager to determine Presumptive Financial Assistance and account routing to our new cloud-based dialer solution, PatientDial. Download the full case study Watch the video
Frank Abagnale will present “Stealing Your Life” at HIMSS17 on Monday, Feb. 20, 2017 from 3pm – 4pm. Session #58. Location: Room 320 at the Orange County Convention Center Frank Abagnale is one of the world’s most respected authorities on forgery, fraud, embezzlement, and secure documents. For over 40 years he has worked with, advised, and consulted with hundreds of financial institutions, corporations and government agencies around the world. Mr. Abagnale’s rare blend of knowledge and expertise began more than 50 years ago when he was known as one of the world’s most famous con men. Mr. Abagnale will bring his audience up-to-date with all aspects of identity theft, data breaches, medical identity theft and the means used to obtain peoples identities. He will discuss the importance of identity management healthcare organizations. After the presentation, Mr. Abagnale will be in the Experian Health booth #3503 to meet and greet HIMSS attendees. We invite you come by our booth to meet Mr. Abagnale! Click here for more information on the presentation.
Your organization would make a great participant in our Universal Patient Network. We’ve developed a unique solution leveraging Experian’s demographic data to establish a universal patient identifier, which has higher match performance than standard industry tools. We would like to offer YOU an opportunity to leverage our Universal Identity Manager (UIM) Batch product at NO CHARGE.* What you give: Patient demographic data in a secure file/message What you get: File with Universal Patient Identifier (UPI) and identified duplicates (at your specific frequency) How you benefit: Information exchange, care coordination, patient safety, operational efficiency and financial savings Your organization can address duplicate issues and be at the forefront of promoting a universal patient identifier. Contact Experian Health today to learn more! Visit www.experian.com/umpi, email experianhealth@experian.com or call 1 888 661 5657. *Offer is limited to Experian Health’s UIM Batch Process product and shall remain open for such time as Experian Health may decide.
Experian Health and NCPDP (National Council for Prescription Drug Programs) have joined forces to introduce a vendor-neutral solution that powers a national patient identifier. Experian Health and NCPDP have announced a strategic alliance to provide a vendor neutral solution to address the complexities of managing patient identification. With a shared vision to create solutions and leverage data for the common good, this alliance brings an innovative matching solution that provides the framework for establishing a unique patient identifier to address patient safety, financial and operational challenges across the U.S. healthcare ecosystem. Read the press release here.
Below is a collection of some of most compelling article we\'ve read in recent months. We hope you find these interesting, too! One Goal; One Contract: How a Nationwide Health Data Sharing Framework is Revolutionizing Interoperability http://www.himss.org/news/one-goal-one-contract-how-nationwide-health-data-sharing-framework-revolutionizing-interoperability 7 things to know about Aetna\'s ACA exchange exit http://www.beckershospitalreview.com/payer-issues/7-things-to-know-about-aetna-s-aca-exchange-exit.html 5 steps to cybersecurity for Internet of Things medical devices http://www.healthcareitnews.com/news/5-steps-cybersecurity-internet-things-medical-devices CMS: ICD-10 specificity kicks in Oct. 1, 2016 http://www.healthcareitnews.com/news/cms-icd-10-specificity-kicks-oct-1-2016 3 leadership skills crucial for a culture change http://www.beckershospitalreview.com/hospital-management-administration/3-leadership-skills-crucial-for-a-culture-change.html
Undoubtedly, you have been monitoring progress toward legislation for healthcare providers to furnish patients with estimates for their cost of care. And if it’s not already in place, there’s a strong chance your state will be next on the list to require price transparency. Additionally, with the continued popularity of high deductible health plans, patients are looking to price shop for their healthcare services. Patients expect more healthcare cost information available online, like in every other industry. Helping patients know what they will owe prior to service can enable them to make more informed decisions about their care and increase patient satisfaction. As more states begin to mandate providing pre-service estimates to patients, it’s critical for healthcare providers to know what solutions are available to help them comply. According to a recent Fierce Healthcare article, “Real healthcare price transparency for consumers is dependent on rich data sources that provide meaningful price information on a wide range of procedures and services.1\" Experian Health is here to help! Our Patient Estimates solution is a pricing transparency tool that enables you to create accurate estimates of services, before or at the point-of-service. Patient Estimates is also offered within our Patient Self-Service portal, allowing patients to access estimates on-demand. See how Patient Estimates helped St. Clair Hospital in the Pittsburgh market. According to the June 2016 KLAS Healthcare Price Transparency Solutions Performance Report, “…clients feel [Experian Health’s] Patient Estimates is a critical element in their efforts to help patients know up front what their costs will be, and clients report overall satisfaction with the product, services, and vendor engagement. The solution is seen as very complete and robust, with strong customer support.” Experian Health\'s Patient Estimates can help your organization: Increase up-front collections Provide patient’s pricing prior to service Increase patient satisfaction Let us help you prepare now for state requirements that will ultimately increase accurate up-front collections and more importantly improve patient satisfaction! Call us at 1 888 661 5657 or email experianhealth@experian.com to get started! 1Ron Shinkman, “A few more states get passing grades on price transparency,” Fierce Healthcare, July 28, 2016
Scott Lee oversees the Experian Health Reference Program. Scott graduated with a BA in Business Management from The University of Texas at San Antonio, and has been with the organization for 12 years, beginning with MPV, which was acquired by Experian in 2011. Scott lives in San Antonio with his wife and two children and says his second home is the San Antonio Zoo based on how much time he and his family spend there. Scott is a catalyst for fostering the connection between Experian Health’s current and potential clients to allow the former to share their positive experience and ROI using our solutions. Our clients also benefit from being a reference by learning about the workflow and best practices of similar organizations. Because of the importance of protecting our clients’ privacy, Scott schedules calls on behalf of our clients and ensures that the experience is mutually beneficial and minimally disruptive for all parties involved. “We’re very appreciative of our reference clients, and it’s a privilege for our potential clients to hear their experiences firsthand.” he said. Share your story by being an Experian Health Reference Client! Contact your Sales Director/Account Manager or contact Scott Lee at scott.lee@experian.com or (210) 582-6320.
