All posts by Experian Health
The manual process for fielding scheduling calls isn\'t an easy one. Calls can take up to 20 minutes, and call center agents may have to comb through binders or spreadsheets of provider calendars and scheduling rules to book a single appointment. As a result, call center staff may only be able to place a handful of patients per day, despite receiving hundreds of scheduling calls. This not only contributes to a poor patient experience but can cause care delays and potentially push patients to seek care from surrounding competitors. Prior to working with Experian Health, call center agents at Heritage Medical Associates were manually scheduling patients with the process described above, and only able to place three to five patients per day with calls lasting several minutes. With Experian Health’s call center scheduling solution in place, call center agents now have access to all of the organization’s 135+ providers in a single digital platform. With an integration with Allscripts, call center agents can see all available appointments in real-time, identify the best provider and appointment for a patient’s specific care need and then book the appointment on the spot. Heritage Medical Associates has seen several improvements since working with Experian Health. Increased call center efficiency. The time spent on the phone for scheduling an appointment has been nearly cut in half — from seven minutes down to just four. With more time, call center agents can now place between 40 and 50 patients per day. Improved patient experience. Patients who called in to book an appointment, reported higher levels of satisfaction as they were able to navigate to the right provider and appointment more quickly. Enhanced physician satisfaction. By automating their scheduling rules, providers can ensure that any open appointment slots are booked according to their personal preferences. They can better predict their schedules and maintain control over their calendars with the new solution. Improvements to the bottom line. As each individual provider and separate location becomes more efficient, Heritage Medical Associates as a whole has been able to control overhead and has seen quantifiable improvement to its bottom line. “The physicians that I’ve talked with so far find that they have a more efficient and planned day, and it’s more relaxing. Their productivity is increased, and, at the same time, they’ve been able to reduce some of the stresses of their schedule.” — Jim Browne, Chief Executive Officer, Heritage Medical Associates Learn more about how you can improve call center efficiency and the patient experience with guided search and scheduling.
As every healthcare executive knows, a healthy revenue cycle relies on precise paperwork. That’s why all Medicare providers should be paying close attention to the revised medical necessity form, which will be mandatory starting January 1, 2021. Failure to use the new Advance Beneficiary Notice of Non-coverage (ABN) form could lead to denied claims, financial penalties and a subpar patient experience. We interviewed Theresa Marshall, senior director of data compliance at Experian Health, about what’s changed and what providers can do to prepare. What is a medical necessity form? Medicare only pays for services and procedures considered “medically necessary.” In situations where a procedure isn’t considered medically necessary, providers must issue the patient with an ABN which ultimately transfers financial responsibility to the patient. Services that could be considered medically unnecessary might include treatment in hospital that could have been provided in a lower-cost setting, screening or therapies that are unrelated to the patient’s symptoms, or hospital stays that exceed a specified length of time. Perhaps a patient is receiving support with personal care from a home health agency – this may not be strictly medically necessary, so the provider might anticipate that it won’t be covered by Medicare. An ABN isn’t required for services that are never covered by Medicare, such as dental care or cosmetic surgery. What’s changed on the new medical necessity form? The new form, CMS-R-131, replaces the version released by CMS in June 2017. The main change is the addition of new instructions for Dual Eligible beneficiaries. These are patients who are eligible for both Medicare and Medicaid, and most likely enrolled in the Qualified Medicare Beneficiary Program (QMB), which means Medicaid pays for any Medicare-covered services. Providers must not levy any charges against QMB patients, or they’ll face sanctions. The new instructions specify that in addition to edits that strike through specific language, “dually eligible beneficiaries must be instructed to check Option Box 1 on the ABN for a claim to be submitted for Medicare adjudication.” How should providers prepare? Should they chose, providers can start using the new form now. The important thing to remember is that they must have the new form in place by the new year. Any outdated forms after the first of the year will be invalid. Many providers are still using manual processes which require checking medical necessity rules for both Medicare and commercial payers via the CMS website, then calculating and preparing the required paperwork themselves. This can be time-consuming and vulnerable to errors, which also results in denied claims and extra days in accounts receivable (A/R) – not to mention the extra stress it causes for patients. A time-saving alternative is an automated tool such as Experian Health’s Medical Necessity. With automation, you can validate clinical orders against payer rules quickly and accurately, for cleaner claims the first time around. Medical Necessity integrates seamlessly with multiple electronic medical records (EMR), scheduling and registration systems, to run automatic checks for medical necessity, frequency and duplication. With up to half of denied claims occurring early in the revenue cycle, any actions to minimize errors and delays during registration could bring big financial benefits. Medical Necessity from Experian Health will include an automatic check of a Medicare beneficiary’s QMB status ahead of the January 2021 deadline, so the electronic ABN can be updated immediately, ready for the patient’s signature. Could this improve the patient experience? Yes, definitely. In addition to reducing manual processes, preventing denied claims and protecting against lost revenue and financial sanctions, automating medical necessity checks also creates a much less stressful experience for patients. For individuals who are financially vulnerable, any lack of clarity about their medical bills can be a huge source of worry. But when providers can quickly identify patients who shouldn’t be charged, the billing experience is a much smoother ride. Medical Necessity is just one of the many ways that Experian is working to reduce the burden on hospital resources, improve patient experiences, and ensure that hospitals are fully compensated for the care they provide. Find out how we can help your organization get your paperwork in order in time for the new ABN requirements in January 2021, so you can offer a better patient experience and reduce claim denials at the same time.
Visits to emergency departments (ED) dropped by 42% in the early months of COVID-19, according to the CDC. In pre-pandemic times, this might have been a positive sign. Two-thirds of ED visits are thought to be avoidable, with emergency care used as a safety net in the absence of access to more appropriate services. Excessive emergency care also comes with a high price, often resulting in a poor patient experience. UnitedHealth Group estimates that the 18 million preventable visits per year cost the health system up to $32 billion annually. Unfortunately, the rapid decrease in ED use during the pandemic isn’t a signal that care management and access challenges have been resolved. Social distancing, stay-at-home orders and fear of being exposed to COVID-19 have prompted patients to avoid seeking care in person altogether. Inevitably, as more individuals either postpone or forego the care they need, ED use will start to creep back up again. For health plans, the worry is a sudden influx of their members returning to emergency departments with more complex care needs arising from delayed treatment. Medical costs could sky-rocket, while gaps in care could reach critical levels as health plans and providers struggle to keep track of ED admissions and readmissions. As health plans look to curb ED utilization in the aftermath of COVID-19, digital tools can provide a valuable lifeline. 4 ways health plans can use digital tools to reduce unnecessary ED visits 1. Take action to engage members before acute episodes occur Proactively involving members in their own care management can help head off unnecessary ED visits before they’re even a possibility. Understanding how the social determinants of health affect a member and how they access care can help health plans tailor their engagement strategies and close gaps in care. Experian Health’s Member Engagement Solutions draw together all the insights needed to connect the dots between emergency visits, social and economic risk factors, and digital care coordination, so health plans can communicate with members in the most effective way. 2. Make it easier for members to access care when they need it Part of the ED visit volume is based on members’ frustration of not being able to access care when they want or need it. Health plans can prevent unnecessary ED visits by sending automated outreach prompts to encourage members to schedule appointments, via interactive voice response or text. A digital scheduling platform can give the member an easy way to book their appointment, without needing to call during office hours. With digital scheduling, health plan member engagement teams and call centers can facilitate member appointment scheduling with the right providers without the cumbersome three-way call. 3. Implement a real-time tracking strategy for ED admissions One of the biggest challenges for health plans is not knowing when members are admitted to the emergency department. A tool such as MemberMatch® can alert health plans of their members’ real-time ED encounters, so they can rally around active episodes of care – potentially avoiding unnecessary, out-of-network admissions and readmissions – and optimize the cost and quality of encounters across the continuum of care post-discharge. Using Experian Health’s leading referential matching system, a member’s care team can be notified via text, portal or email for quick insights that enable better care coordination. 4. Ensure better management of post-discharge follow-up care Every health plan’s checklist for reducing readmissions should include a follow-up strategy when patients have visited the ED. Given that post-ED follow-up for members with chronic conditions is likely to be a STAR measure in the future, plans should prepare their proactive intervention strategy now. USMD WellMed Health System used Experian Health’s Member Utilization Management Solutions for better care coordination for patients within 30 or 90 days of leaving hospital, significantly reducing their readmissions rate. Within just four months, the ROI trends gave them confidence to roll out Care Coordination Manager from USMD clinics to WellMed clinics too. Reducing admissions and readmissions is not about making access to the ED more difficult, but making access to other services, care options, and care management solutions easier. With the right digital solutions, health plans can take action to make this unprecedented transition of care from the ED to other, more cost-effective arenas the ‘new normal’ and put the old model of ED over-utilization in the past. Contact us to learn more about how Experian Health can help health plan reduce unnecessary ED visits.
Halloween might be over, but healthcare fraud – or simple input errors – can transform a patient’s identity into something completely different. The negative impacts are potentially far-reaching, haunting both patients and providers. Is the patient standing in front of you really who they say they are? Learn more about Experian Health\'s identity management solutions and how we can help you match, manage and protect patient data with:
A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch? The pandemic has prompted people to engage with their own care in a way the industry hasn’t seen before, with a surge in telehealth and virtual care. Infection-control forced much of the patient journey online, while providers were pushed to find new ways to communicate quickly and clearly. Now, those with an eye on the road to post COVID-19 financial recovery are optimizing these digital strategies to meet new consumer expectations and improve patient loyalty. Embracing digital technology and automation throughout the entire patient journey will be key to patient acquisition and retention. Where should providers focus first? 4 consumer-led strategies to keep patients loyal 1. Prioritize convenience across the entire consumer experience Eighty percent of patients would switch providers for convenience factors alone – ranking ‘convenient, easy access’ ahead of insurance coverage and quality of care. Creating a digital experience that gives patients the flexibility and simplicity they desire should be priority number one in any patient loyalty plan. Providers can start by reviewing their digital platforms. Encourage patients to use their patient portal to access information, book appointments and manage their healthcare when appropriate. Telehealth and virtual care solutions can be future-proofed with reliable identity protection, so patients can safely access care from home and not worry about cumbersome log-in procedures. 2. Make patient access…accessible The patient experience shouldn’t begin with time-consuming forms, long waits and error-prone manual intake processes. Rather, providers can make it easy for patients to complete as many tasks as possible BEFORE they set foot in the office by automating patient access. Online patient scheduling lets patients book, cancel and change appointments online – which 77% of patients say is very important. It has the potential to reduce delays and no-shows, and can minimize the administrative burden for provider staff. While patients remain concerned about the risk of infection during COVID-19, providers can ease their concerns by reducing face-to-face contact with online pre-registration. 3. Respond to affordability and pricing pain points One Experian Health study found that the top pain points in the consumer journey center on the financial experience, from shopping for health insurance to understanding medical bills. Patients may be unsure what their insurance covers, whether their deductible has been met and whether they can afford the out-of-pocket costs. By providing clear, upfront pricing information about coverage and financial responsibility, providers can protect their patients from unnecessary surprises and reduce the risk of missed payments. Self-service patient payment tools can simplify the payment process too: patients can settle their bills anytime, anywhere, and get advice on financial assistance and best-fit payment plans. 4. Personalize the patient experience from end to end A one-size-fits-all approach doesn’t cut it anymore. Patients are looking for communications and services tailored to their individual needs. That used to be both technically and logistically impossible, but not anymore. Providers today can use comprehensive data and analytics to personalize the entire healthcare journey, from customer relationship management to patient collections. By combining automation, self-service tools and accurate insights into the patient’s circumstances, providers can help consumers make better decisions about their care and how to pay for it. To ensure data reliability and integrity, providers should consider partnering with a trusted data vendor, who can translate robust, multi-source consumer and financial data into a competitive consumer experience. There is no question that COVID-19 has changed the way we do healthcare, but the industry is perfectly posed to harness the change in consumer behavior and shift towards greater patient engagement. By bringing together a myriad of digital tools, providers can create a healthcare experience that’s convenient, compassionate and in line with consumer expectations. Interested in learning more about how we can help your organization welcome new patients through its digital door, and boost loyalty among existing patients?
“It’s important to provide our patients with the absolute best access channels to quickly and seamlessly connect with the care they need. Experian Health’s solution guides our patients to the right care and digitally connects them with a confirmed appointment.” - Kaci Husted, Vice President, Benefis Health System It’s shouldn’t come as a surprise that patients today want their healthcare experience to mirror the flexibility and convenience that they are now accustomed to with other industries. Notably, patients want easier and faster access to care, and preferably without having to pick up the phone to call and make an appointment. Benefis Health System knew it needed to provide patients with a new and improved access experience. Patients were required to call the office during business hours to book an appointment, and while some may have been immediately connected with a scheduler, others would have to leave a voicemail or be placed on hold. The process was not only taking valuable time out of patients’ days but carried the risk of delaying care. With online self-scheduling in place, patients can schedule an appointment online with any of Benefis Health System’s 300+ providers, regardless of time of day. The solution leverages powerful decision support, which guides patients directly into the appointment type and provider necessary for the treatment they need. It’s good for patients and providers, as the solution’s accuracy prevents any misplacement of patients to the wrong provider or appointment type. Patients started using the self-scheduling solution almost immediately after it was available. Benefis Health System has since experienced the following results: Improved access to care. Patients of Benefis Health System have used the system to book many appointments outside of office hours, with 50% of its patient base booking after hours. Better access to urgent care. One of Benefis Health System’s urgent care centers has seen a large uptick in online self-scheduling. In fact, 52% of patients are scheduling appointments online for that location. Ongoing improvements with analytics. Benefis Health System is leveraging analytics to track how many patients use online self-scheduling and can identify when and where they might fall out. They can see the pitfalls and where improvements may be necessary and make those changes in real time to drive better conversion rates. Currently, 23.6% of patients who start the process are converting to a booked appointment. Interested to see how online self-scheduling can help your organization improve access to care?
In previous winters, anyone struck by a sore throat or fever might assume they had flu, and head to bed with a hot drink and some painkillers. This year, the looming specter of COVID-19 could prompt those with flu-like symptoms to seek medical care instead. Combined with a likely second wave of COVID-19 cases as lockdown requirements relax, healthcare organizations anticipate a surge in patients seeking tests and treatment this winter. To protect against a possible “twindemic”, where COVID-19 and winter flu season collide, providers will want to ensure the patient intake and access process is as easy and efficient as possible—and not just for regular appointments with a primary care physician or specialist, but for pandemic- and flu-related services like COVID tests, flu shots, and more. Online scheduling has been a game-changer during the pandemic: could it be the key to surviving a twindemic? With the right digital tools in place, providers can screen patients for their COVID-19 or flu risk before attending an in-person appointment, helping separate healthy patients from those suspected of having either illness. Providers can also leverage those same digital tools to streamline activity like flu shots, or even drive-through testing for COVID-19. Four ways to leverage digital scheduling for a twindemic These four steps could be key to protecting patients, streamlining workflows and reducing pressures on call centers during flu season as it collides with COVID-19: 1. Create screening questionnaires during patient scheduling As soon as the patient logs on to book an appointment, they are asked to answer a few short questions about their symptoms. A screening questionnaire can triage people wanting to get tested, while the answers inform providers of the likelihood of a patient having COVID-19 and if that individual needs to quarantine. After being screened, the system can direct patients through the correct channel of care based on the information provided. A similar questionnaire could be adapted during flu season for providers to assess and compare symptoms and risks ahead of time. Providers can even designate day and time slots available to patients for flu vaccinations, making it easy for patients to schedule on their own time and further minimizing the risk of unnecessary contact with other patients in office. 2. Direct patients to drive-through testing to minimize in-person tests Depending on the answers given during screening, patients may be directed to virtual and disease-specific care, such as drive-through COVID-testing. An online scheduling platform can easily be used to book appointments for tests, presenting patients with any available time slots, either same-day or a few days out. The platform can also record information about the patient’s vehicle to quickly identify patients and avoid bottlenecks in the drive-through. With so many patients hesitant to show for in-person visits today, a similar system for flu shots could serve providers well. 3. Use guided search to direct patients to the right virtual services Virtual care has proven both necessary and valuable during the current pandemic. Not only has it kept patients in close contact with providers and specialists, but it has helped providers capture revenue lost from the cancellation or delay of in-person appointments. Virtual care will be increasingly critical during a dual COVID-19/flu season. By asking the right questions during online scheduling, patients can be connected to the correct provider, whether virtual or in-person, for their needs and book an appointment quickly and easily. 4. Eliminate walk-through traffic at urgent care centers Urgent care centers are already known to be the ‘doctor of choice’ for many patients, but this could pose a few challenges for both patients and providers during a dual pandemic. Rather than be a gathering spot for patients with both illnesses, urgent care centers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This can help reduce the number of in-person visits and walk-in traffic, which will not only help keep everyone safe and healthy but contribute to a far better patient experience as patients wouldn’t have to sit and wait to be seen by a provider. Interested in hearing more about how online scheduling could help your organization manage flu season as it collies with COVID-19?
While all hospitals and health systems will no doubt encounter revenue-specific challenges related to the pandemic, a solid foundation and targeted approach for improved collections can help speed up the road to recovery. In fact, it was Sanford Health’s unique approach to increasing patient collections that allowed it to both optimize collections during the pandemic and improve employee satisfaction and retention. Several years prior to COVID-19, Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies. Leveraging Collections Optimization Manager and PatientDial from Experian Health, Sanford was able to quickly and easily streamline call center operations and increase collections in a myriad of ways – through new and updated patient addresses, patient-friendly billing statements, identifying new guarantors and more. With the above items in place, Sanford was already well positioned to seamlessly manage normal business operations during a pandemic. The organization was able to quickly adapt, and then build on that momentum to better serve its patients and staff, while also driving results. Since the start of COVID-19, Sanford has: Increased employee satisfaction with remote capabilities PatientDial allowed Sanford to seamlessly transition its call center team to work remote. Where about 30% of the workforce was remote prior to COVID-19, just shy of 99% of call center representatives are now remote. This has been a great source of employee satisfaction and safety and has aided in the system’s ability to keep the collections momentum going. Provided a more compassionate approach to collections Recognizing that this is a sensitive time for many, Sanford ensured the proper mechanisms were in place to identify those who required additional help, offering the best methods for collection possible. Sanford has not only created a billing indicator for patients affected by COVID-19, but Experian Health has provided additional insight with a weekly file of patients who are identified as possibly financially stressed. Improved collections during time of crisis While collections decreased for the quarter, Sanford saw a record increase in collections for the month of March -- $800K more than the system saw in March of 2019.
Before working with Experian Health, call center operations at Sanford Health were disparate and disjointed, with each call center operating on a different phone system with different carriers. While some centers saw high abandonment rates, others were waiting around for calls. Although Sanford attempted to create balance by placing accounts in a work queue, the process for managing outbound collection calls remained manual and it was impossible to identify and strategically contact patients based on ability to pay. Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies. Since working with Experian Health, Sanford now has a focused approach to managing accounts receivable (AR) by identifying patients with a certain propensity to pay. Collections Optimization Manager allows Sanford to quickly identify a pathway and delivery to resolution of the patient’s balance. The analytical segmentation models within Collections Optimization Manager use precise algorithms that reveal those patients who likely are eligible for charity services, those who might prefer to pay in full at a discount, or those who might benefit from a payment plan. The solution then feeds segmentation data to PatientDial, which Sanford uses to route calls to 70 patient account representatives. Sanford also implemented a re-designed, more user-friendly patient statement format. The improved cover page offers easy-to-understand information about the bill including the available options for payment. In a larger effort to improve the patient experience, Sanford implemented an employee incentive program that appropriately rewards staff based on their collections’ performance. Since working with Experian Health, Sanford has seen the following improvements: Streamlined call center operations. With PatientDial in place, Sanford was able to consolidate its call center team members in 4 regions and seamlessly operate on centralized toll free and direct dial numbers. Where it used to take on average 56 seconds for a call to be answered, calls are now answered in 20 seconds or less. The system now comfortably manages an average of 12,000 inbound calls weekly. Increased collections. The model in place has allowed Sanford to improve collections in a myriad of ways. In addition to increased collections from calls made through PatientDial, Sanford was able to see an additional $2.5M in patient payments by ensuring patient statements were sent to the new or correct address. The system found an additional $60K by identifying new guarantors for accounts of deceased patients. The segmentation capabilities from Experian Health also enabled Sanford to identify patients struggling with bankruptcy, allowing staff to focus their efforts on collectible accounts and more efficiently direct individuals to charity options. Learn more about Sanford Health’s journey and how a similar approach could help your organization improve collections and employee satisfaction.
