Collections Optimization

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 Any outdated forms after the first of the year will be invalid.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.

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.

Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve collections, providers are often tasked with finding this information on the spot. Historically, providers have used demographic information like Social Security Numbers (SSN) as a means to verify patient identities and locate this information, but that tactic is increasingly unreliable as it is possible for more than one person to use the same SSN and SSNs are a lucrative route to stealing someone’s identity. With this in mind, many health plans are no longer using SSNs as an identifying number for insurance coverage. In fact, the Centers for Medicare & Medicaid Services recently removed SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status. The latest health plans to remove this piece of demographic information is Health Net Medi-Cal and Health Net National. Effective September 25, 2020, the search options for eligibility for this plan have changed. Providers will ONLY be able to find and verify coverage with a subscriber ID. "Providers are often tasked with finding this information on the spot." While Health Net Medi-Cal and Health Net National are the latest health plans to do away with demographic searches, it’s certainly not a surprising trend and more will likely follow suit. Bridging the gap with historical data Uncovering previously unidentified coverage is critical for providers as it helps to eliminate costly self-pay situations, bad debt write-offs and unwarranted charity designations. And, without the proper insurance information, patients also risk delayed access to care and other financial hardships. With demographic searches on the decline, providers will need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage. Combining search best practices, multiple proprietary databases and historical information, Experian Health’s Coverage Discovery locates patients' billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process. A tool like Coverage Discovery is even more beneficial for providers during COVID-19, where limitations of face-to-face contact make it more difficult to complete the usual coverage checks. Coverage Discovery empowers providers to facilitate coverage checks remotely, avoiding delayed reimbursements during a time when revenue streams are already feeling pressure. "As a data-driven company with a historical repository of data, Experian Health is uniquely positioned to help providers search for coverage." Want to learn more? Contact us to see how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.

Few of us would buy a new car or TV without checking the price tag first. Why should our healthcare be any different? Yet this is exactly what many patients are forced to do when they need medical tests or treatment. Following the breadcrumbs on a provider’s website is a time-consuming and confusing way for patients to piece together a price estimate. Even with a rough idea of the cost of care, variations in health plan pricing often bump up the final bill. The lack of transparency is stressful for patients and costly for providers, who end up chasing slow payments and losing revenue to bad debt. But could things be about to change? Many providers have been proactive in offering transparent pricing, and thanks to recent regulatory changes, this could soon be an industry-wide requirement. The CMS Price Transparency Final Rule mandates that by 1 January 2021, hospitals should publish consumer-friendly pricing information on certain ‘shoppable’ services, to help patients understand and plan their bills ahead of time. The proposed Health PRICE Transparency Act would similarly compel providers to publish real cash prices alongside rates negotiated with insurers. As households, businesses and public bodies grapple with the economic impact of COVID-19, any additional clarity around pricing that could help make a dent in healthcare-related debt is to be welcomed. Liz Serie, Director of Product Management and Patient Experience at Experian Health, says that regardless of changes to the regulatory landscape, pricing transparency is here to stay: “It’s great for the patient because they have visibility, transparency and clarity about what they owe. They can prepare financially before their visit, so they can focus on what matters most – healing. Providers are excited about price transparency tools because they let patients pick and plan payment options, reducing the total cost to collect. And with more reliable billing data, it’s a win from a decision-making perspective too.” Transparency is becoming the norm in other aspects of healthcare consumer experience, and billing should be no different. 4 steps to fast and simple patient-friendly pricing 1. Remove the guesswork with accurate, upfront pricing estimates No one wants to play detective with their deductibles. Giving patients pricing information upfront puts them in control of their payments, improving their engagement and increasing the likelihood of faster collections – a top priority for providers today as they continue to feel the effects of COVID-19 on the bottom line. A Patient Estimates tool can generate accurate, easy-to-understand estimates based on known treatment costs, payer rates and real-time benefits data. Estimates and secure payment options can be sent straight to the patient’s mobile device, improving the patient financial experience with a single text message. 2. Give patients 24/7 control through their online portal With COVID-19 pushing even more of our lives online, a 24/7 patient portal is a must for providers that want to stay competitive. Yale New Haven Health (YNHH) used PatientSimple to give patients a mobile-friendly, self-service portal through which they can generate price estimates, choose payment plans, and monitor payment information. Sharlene Seidman, Executive Director Corporate Business Services at YNHH says patients have welcomed online access: “ROI is not just tangible dollars in additional revenue, it’s patient satisfaction and improving the financial experience.” 3. Minimize delayed payments with quicker insurance checks Millions of Americans have experienced sudden job losses or changes to their insurance status in the wake of the pandemic, causing confusion about their current coverage. Payment delays and denied claims are an inevitable side-effect. Providers can help by offering fast, automated insurance eligibility verification, so patients can confirm coverage at the point of service and take the next steps with confidence. 4. Move to mobile for a more convenient patient experience Imagine if your patients could have all the information they need about their healthcare account, right there in their pocket. Patient Payment Solutions offer real-time pricing estimates based on provider pricing, payer rates and benefit information, so patients can review their bill at a time and place that suits them. There’s also the option to offer secure and contactless payment methods, so they can settle their bill at the click of a button. Estimates suggest that the average family of four could save up to $11,000 a year if they had the option to choose care on the basis of more transparent pricing. Savings on this scale mean that demand for clear information about out-of-pocket expenses is going to soar, whatever happens with price transparency regulations. Learn how Experian Health can help your organization support patients and improve collections through more transparent pricing.

Financial recovery after COVID-19 is likely to be a slow burn for most healthcare organizations, according to a recent survey. Nearly 90% of healthcare executives expect revenue to drop below pre-pandemic levels by the end of 2020, with one in five anticipating a hit greater than 30%. While the return of elective procedures will be a lifeline for many hospitals and health systems, the road to financial recovery remains fraught with obstacles: Five months of canceled and postponed procedures need to be rescheduledWorried patients must be reassured of hygiene measures, so they feel safe to attend appointmentsPatient intake and payment processes must be modified, in order to minimize face-to-face contactAs the rate of infection continues to grow, providers must find new ways to also grow their revenue and protect against a further dent in profits. The healthcare industry is unlikely to see the recovery curve hoped for across the wider economy, but digital technology, automation and advanced data analytics could help provider finances to bounce back more quickly. 4 ways technology can accelerate your post-pandemic financial recovery 1. Easy and convenient patient scheduling unlocks your digital front door Patients want to reschedule appointments that were postponed or canceled over the last few months. To manage the backlog and minimize pressure on staff, consider using a digital patient scheduling platform, so patients can book their appointments online. A self-scheduling system that incorporates real-time scheduling and calendar reminders will help to create a positive consumer experience, while offering analytics and behind-the-scenes integration to keep your call center operations running smoothly. 2. Secure and convenient mobile technology can enhance your telehealth services Telehealth is the top choice for many hospitals looking to boost revenue growth and counter the impact of COVID-19, with two-thirds of executives expecting to use telehealth at least five times more than before the coronavirus hit. Many new digital tools and strategies designed to improve the patient journey as a whole can support telehealth delivery, and help to meet growing consumer demand for virtual care. For those beginning their telehealth journey, our COVID-19 Resource Center, which offers free access to telehealth payer policy alerts, may be the place to start. 3. A digital patient intake experience can lessen fears of exposure Although many providers are starting to open up for routine in-person appointments again, patients may wonder if it’s safe. Proactive communication about the measures in place to protect staff and patients will be essential. Another way to minimize concern is to allow as many patient intake tasks as possible to be completed online. Automating patient access through the patient portal can give patients quicker and more convenient ways to complete pre-registration, while contactless payment methods are a safe way to settle bills without setting foot in the provider’s office. 4. Optimize collections to bolster financial recoveryAutomation can also play a huge role in helping providers tighten up their revenue cycle, find new ways to enhance accounts receivable collections and avoid bad debt. Tools such as Coverage Discovery and Patient Financial Clearance enable providers to find missing or forgotten coverage, and help the patient manage any remaining balances in a sensitive and personalized way. Palo Pinto General Hospital uses automated coverage checks to find out whether a patient is eligible for charitable assistance within three seconds, so self-pay accounts can be directed to the most appropriate payment plan before the patient even comes in for treatment. With fewer accounts being written off, Palo Pinto has seen a noticeable improvement to their bottom line. The pandemic has been a wake-up call for an industry that has been traditionally slow to adopt new technologies. Ahead of a second wave of COVID-19, providers must move now to take advantage of automation and digital strategies to speed up financial recovery. Contact us to find out how we can help your organization use technology to improve the patient experience, increase efficiencies and kickstart your revenue cycle.

With a vaccine for COVID-19 thought to be at least a year away, healthcare providers are steeling themselves for even more cases in the fall. The big worry is that a surge in cases will hit the health system just as flu season takes hold. In a recent interview, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC), warned that “the assault of the virus on our nation next winter [may] actually be even more difficult than the one we just went through… we’re going to have the flu epidemic and the coronavirus epidemic at the same time.” Healthcare organizations are accustomed to an influx of sick patients between October and March: around 62,000 people died and more than 700,000 were hospitalized during last winter’s flu season. With 130,000 Americans losing their lives to COVID-19 in just four months, what could happen when the two respiratory diseases collide? Large numbers of patients with either virus (or potentially with both) will put renewed pressure on staff and services that are already under immense strain. Hospitals will need to prepare to manage both groups of patients as efficiently and safely as possible. Five ways to ease stress, paperwork and patient concerns ahead of a dual epidemic 1. Use data to drive your patient engagement strategy Create a flu preparedness patient engagement strategy to keep patients informed of how best to protect themselves in the context of a dual epidemic. As a result of the coronavirus pandemic, patients may be more familiar with telehealth services as a “contact-free” alternative to in-person appointments, so you’ll want to continue to promote these to minimize the spread of infection. With consumer data, you can segment patients according to risk and automate your communications, so they get the most relevant message at the most convenient time. 2. Relieve pressure on staff with automated patient scheduling Digital scheduling gives patients the option to book appointments online, at a time and place that suits them. This reduces pressure on call center staff and can give providers control over the volume and timing of in-person appointments, thus helping to reduce the spread of germs. An online patient scheduling platform can automate the entire scheduling process, integrating in real-time with your records management systems and connecting to your referral providers’ systems for a seamless patient and staff experience. 3. Screen patients proactively to discover their needs ahead of time Asking patients to fill out electronic questionnaires before their visit means their access needs can be identified and addressed before they come in. Do they need help to find transportation? Will they face any challenges in picking up a prescription? Is there something that could stand in the way of follow-up care? Screening for social determinants of health can answer these questions so you can direct patients to the most appropriate care and support. 4. Enable digital patient registration for a quick and easy intake experience Speed up the registration process by giving patients the option to complete their intake admin by phone or through their patient portal. Not only will this reduce the spread of infection in busy waiting rooms, it’ll make for a more enjoyable patient experience and free up limited staff resources for other priorities. With automated registration and consumer-facing mobile experiences, you can improve the patient experience, operational efficiencies and data accuracy all at the same time. 5. Minimize in-person interactions with contactless payments Encourage patients to clear their balances without having to hand over cash or access payment kiosks. Self-service digital payment tools allow patients to make contactless payments through their patient portal or from their mobile device. It’s in line with consumer expectations, and it could also increase patient collections: Saratoga Hospital saw point-of-service collections increase by 50% after implementing more user-friendly patient payment options. “The combined pressure from two viruses hitting health systems at once means it’s even more important for providers to leverage data for speed and accuracy. Automated workflows can help accelerate operational efficiency, as well as create a better patient experience during what’s already an extremely stressful time.”Karly Rowe, Vice President of Product Development for Experian Health Find out more about how Experian Health’s expertise in data and analytics can help your organization prepare for the coming flu season so you can offer your patients a safe, accessible and stress-free experience. We have also developed a checklist of action items for providers to consider as you prepare for both flu and COVID-19. How ready are you? Which actions is your organization instituting now?

By January 2021, millions of those who suffered job losses in the wake of COVID-19 will see their unemployment insurance end. Medicaid and subsidized coverage under the Affordable Care Act (ACA) will be a safety net for many, but nearly 2 million Americans could find themselves stuck in the ‘coverage gap’, where their household income exceeds the eligibility threshold for Medicaid, yet falls below the lower limit required to receive ACA marketplace subsidies. Without large group or government coverage, these consumers will be left uninsured or forced to purchase individual plans with high deductibles. Considering this will likely contribute to larger patient balances and more struggles with patient collections, many are bracing for a hit to their bottom line. To help minimize accounts receivable and avoid bad debt write-offs, choosing the right data model should be a top priority. Here, we look at one piece that’s often missing from the patient collections puzzle: credit data. Don’t overlook credit data in your self-pay collections strategy Many providers already use demographic and behavioral data to power patient collections, but there can be gaps in what’s known about a consumer’s ability to pay. Credit data can help fill in the blanks. Here are three ways this can be used to optimize your collections strategy: 1. Get a complete view of your patients’ financial situation for faster decision-making Credit data can reveal how a patient is managing other financial obligations, giving you insights about how to handle their healthcare account for a greater chance of payment. Have they just maxed out a credit card? Have they missed a student loan payment or fallen behind on their mortgage? If so, they’re probably going to find it difficult to pay off their medical bill. Knowing this, you can move quickly to help them find alternative coverage or offer a more manageable payment plan. Conversely, if they’ve just bought a new car or paid off a personal loan, there’s a high chance they’re in a good position to pay their medical bills too, so contacting them with a straightforward and easy payment plan means they can clear their balance promptly. 2. Segment patient accounts and allocate them to the right payment pathway The sooner you can get patients onto the right payment pathway, the more robust your cashflow will be. Credit data can help you segment accounts quickly and accurately. Experian Health data shows that when patients are segmented according to propensity to pay, collections increase by around 2% when credit data is included, compared to segmentation without credit data. Martin Health System used Collections Optimization Manager to segment patients and check for available charity support or Medicaid eligibility. By getting patients on the right pathway and making sure agencies were focusing on the right accounts, they increased recovery rates by more than $3.1 million and identified an extra $975,000 in Medicaid coverage in just seven months. 3. Create a more compassionate patient financial experience Using credit data also helps create a more compassionate patient financial experience. Instead of adding to a patient’s financial worries by chasing payments they’ll never be able to cover, you can run charity checks to see if there’s any missed coverage and quickly connect them to the right financial assistance program. A tool such as Collections Optimization Manager lets you segment patients based on their individual circumstances, for a more patient-friendly approach to collections. You can then personalize their communications and payment options so they can manage their expenses with less anxiety and more confidence. Discover why 60% of US hospitals are already using Experian Health’s advanced collections software and unrivaled datasets to optimize patient collections, and find out how we can help you build a resilient revenue cycle as self-pay accounts continue to rise.

Medical expenses are often a source of anxiety for many patients, whether they are unsure about the amount owed or how they’ll ultimately pay for it. Unfortunately, intimidating collections processes don’t help, and a crisis like COVID-19 only exacerbates this stress. A more compassionate billing approach could help patients better navigate their financial obligations and also build long-term loyalty—a necessity for providers today looking to retain patient volume during a time of crisis. Consumers overwhelmingly want to understand the cost of healthcare services, prior to services being performed. Effective price transparency involves offering patients clear, accessible, and easy-to-understand estimates of their financial responsibility for services before they are performed. Give patients clarity from the start with precise pricing estimates and up-front info about what they’ll have to pay can reduce sticker shock, help them plan and create an overall better patient financial experience. By empowering your patients with financial expectations, their feeling of control increases, improving their engagement and the likelihood that you will collect payments faster and more efficiently. Just as you don’t provide identical medical treatment to every patient, processing all patient accounts the same way doesn’t make sense. Every patient is different. Using comprehensive data and advanced analytics, providers can better understand an individual's propensity to pay and make the payment process a positive one by assessing and assigning each patient to the appropriate financial pathway based on their unique financial situation. Medical bills are often the most direct contact providers have with patients after a service is rendered. Unfortunately, money is often a sensitive topic for patients and statements are often overwhelming and difficult for patients to read. Tailoring communications at each stage can convey compassion and increase patient satisfaction. Customizing patient statements gives providers the ability to simplify and customize bills quickly and easily, turning an often confusing process into one that adds value. Including relevant, personalized messages and educational updates can turn billing statements into a useful resource, all with the potential to drive revenue. In addition to offering personalized payment options, providers can also find out whether a patient prefers to discuss billing by phone or email. Minimizing friction at the point of payment is crucial to fostering compassionate collections. Providers should offer flexible options that include in-person, telephone, mobile and online patient portals, so they can pay in a way that’s most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statement. Want to learn more? Check out Experian Health’s Collections Optimization Manager which helps providers segment patients based on an individual’s propensity to pay and payment preferences, informing a compassionate patient engagement strategy and improving collections.