Claims & Contract Management
Improve accuracy and timeliness of net receivables
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.
Below is an update from the Experian Health Support Team. Network & System Performance Last six months: Upgrades to the network, compute and storage infrastructure have improved performance and scalability. Enhanced alerting and reporting to strengthen proactive measures for issues remediation Next six months: Data Center move and consolidation will localize production communications to improve efficiencies Automation improvements to reduce on-boarding times for new clients Subscribe to Receive Product Support Updates Opt in to receive emails about significant product updates or changes. Access the Experian Health Product Dashboard here.
In case you missed them, below are some great tools to help you address key business challenges. Enjoy the read! Press Releases Innovative Mindset Enables Experian Health to Deliver New Capabilities Experian Health Rises to 45 On The 2016 Healthcare Informatics 100 List White Paper Why Start the Payment Process Prior to Service? As a patient’s financial obligation grows, it’s imperative to tailor payment strategies to each unique situation. In pre-service stages, data-driven solutions provide a higher likelihood of securing patient payment. Flexible patient payment plans contribute to a positive billing, payment, and overall engagement experience, as well as a provider’s financial health. Read our white paper to learn more about the importance of the Personalization in the Healthcare Consumer Payment Process. Read Now Article: Healthcare IT Transformation - How Has Ransomware Shifted the Landscape of Healthcare Data Security? Read Now
Did you know that it costs an average of $25 to rework a single claim? It’s true, according to a recent Health IT News article. The article goes on further to state that as many as 65 percent of denied claims remain unresolved because they are too costly to rectify. These unpaid claims eventually become lost revenue. Experian Health’s Denials Workflow Manager and Enhanced Claim Status solutions are part of an integrated revenue cycle platform for healthcare providers to manage payer billing and payment processes. Effective management of these processes directly results in improved cash flow, lower days in A/R, and more efficient operations. Clients converting to our integrated claims and denial solution are experiencing a 50% increase in clean claim rates and faster turnaround on cash. Learn more by visiting our Claims Management page or reserve your spot at one or both of our Claims sessions at the upcoming HFMA ANI conference: June 27 | 1:30pm | Manage Denials to Maximize Reimbursement, Revenue and Cash Flow June 28 | 9:45am | Claims Management
Welcome Katie Zibelin, Experian Health Marketing’s newest team member. Katie made her Experian debut in August 2015 as an intern where she supported client events, tradeshows and proposal efforts behind the scenes. Upon securing her advertising degree from the University of Texas at Austin in December 2015--one semester ahead of schedule--Katie joined the team full time this February. In her current role as a Marketing Coordinator, Katie is responsible for tracking projects, managing vendor activities, conducting tradeshow and vendor research, developing new vendor relationships, coordinating and supervising tradeshow activities and communicating programs and events. Katie also serves as the project leader of our 2016 Regional User Conferences. In her first solo performance at our Southeast Regional Conference in New Orleans, Katie received rave reviews for demonstrating project management and event planning maturity and grace under pressure. Fun Fact: Katie is also an accomplished contemporary dancer/performer/instructor. Please do not hesitate to reach out to Katie with questions regarding any of the upcoming Regional User Conferences at Katie.Zibelin@experianhealth.com.
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.\"
Remember those commercials for the hamburger chain in the mid-1980’s? An elderly lady angrily shouted, “Where’s the beef?” in response to seeing a tiny burger on a large, fluffy bun. If that same creative concept were applied to healthcare today, perhaps the lady would proclaim, “Where’s the data?” when looking at the revenue cycle. While healthcare as a whole is moving toward using clinical data and analytics to enhance patient care, most organizations aren’t realizing the true potential of financial data to drive revenue cycle performance. So where does that potential lie? Quite simply, it lies in the vast amounts of financial data that healthcare organizations can access, yet do so ineffectively. By leveraging this existing data more appropriately, organizations can build and sustain margins while improving performance and enhancing the patient experience. Consider these three areas of opportunity to use data to drive the revenue cycle. Patient Access Correctly capturing and analyzing patient data at the initial point of contact allows an organization to reap large rewards, both clinically and financially. For example, correct patient identification reduces the risks of fraud and identity theft and ensures that medical records are being provided for the right patient, thus preserving patient safety. In addition, using data to provide accurate estimates of the patient’s payment responsibility up front and developing customized payment plans can elevate patient satisfaction as well as propensity to pay, allowing the healthcare organization to enhance collections and reduce bad debt. Claims and Contract Management Another area of opportunity is in payer contracts and claims. During contract negotiations, data and analytics help identify new service line opportunities for enhanced financial performance. Claims are more accurate and efficient when analytical tools review them before submission, comparing them with contract requirements and kicking out those with errors or ones that require further information. Consider the example of a healthcare organization that improved its recovery rate on denials by almost 50 percent by leveraging data to compare the amount received for the claim with the contracted amount. Collections Data and analytics also can be used to improve internal collections efficiency and profitability. Organizations can use data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. This allows collections staff to prioritize work based on a patient’s likelihood to pay, which improves both collections and the patient experience. For example, a patient scoring in the “most likely to pay” segment may not need a call until day 75, while someone in a lower segment may need additional calls and help setting up a payment plan within the first month. Segmenting in this way not only increases the likelihood of successful payment, it preserves patient satisfaction at the same time. Realize your revenue cycle’s true potential by leveraging financial information to enhance performance. Moreover, marry these activities with efforts to use clinical data to improve care, and you can realize a comprehensive approach to elevating overall quality and performance. You’ll no longer need to ask, “where’s the data?” Learn more about leveraging data and analytics to drive the revenue cycle with this white paper: The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance.
