Identity Management
Match, manage, and protect identities
Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage -- vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements? Contact us. Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage
Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions The patient portal can play an important role in COVID-19 vaccination efforts, allowing patients the ability to both schedule their vaccines and keep track of where they are in the process, at least for those vaccines that require more than one dose. We interviewed Victoria Dames, senior director of product management at Experian Health, about how providers can authenticate portal access with automation, while also protecting patient identities. As portal traffic increases, what are the authorization concerns? Many providers who are supporting the mass vaccination sites are leveraging their existing patient portals to schedule patients for the vaccine. As providers are now seeing individuals sign up for portals at scale it can difficult to ensure that the individuals being granted access to the portal are in fact who they say they are. That is a huge concern knowing the patient portal contains PHI that is commonly a target for fraudsters. What are the benefits of automating portal enrollment and access? Automation alleviates two things. First, it provides an industry-wide level of security and assurance. It provides the market standard for identity proofing before granting access to a patient record. Second, it alleviates a lot of the administrative burden put on provider staff. Automating portal enrollment allows staff to focus their attention on other, more important efforts. And, for portal enrollment at this magnitude, automation really is necessary. Providers are seeing individuals going back multiple times to the same portal, signing in more than once and sometimes with multiple log-ins, just to schedule an appointment for a vaccination. Our recent survey on patient access found that 54% of patients are concerned about security when accessing their personal details online. From a provider’s perspective, does having a system like this help with the objective of making patients feel more secure? One area where patient and provider views align is around the security of digital access solutions. The balance, though, between security and convenience can be a tough one to maintain. Moving quickly while maintaining security – and without adding undue friction – is a tall order, but it’s not optional. With the right tools and support, providers can safeguard patient data throughout the vaccination process with confidence and make the portal enrollment process as frictionless as possible. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?
Providers know they need to improve their digital front door to withstand the financial impact of COVID-19, but change can feel risky, especially with so much uncertainty. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. But what do providers see for the future of patient access? And are those views aligned? Providers that offer the most accessible patient access solutions in a post-pandemic world will secure greater patient satisfaction and loyalty.
The urgency to move quickly and vaccinate the population has introduced an entirely new set of challenges for providers regarding patient identity. Many continue to leverage existing processes and solutions already in place, manually handling the pain points that come with them, but now at scale and at an unprecedented rate. As the rollout moves forward, the strain on provider resources will only deepen, as will the risks associated with patient misidentification. The data mess behind the scenes Many patients are registering for the vaccine through a patient portal. While the self-service nature of signing up for the vaccine via a portal is beneficial, patients are unfortunately able to register for a portal account more than once. In fact, some of our clients have reported seeing as many as 1,800 duplicate records created per day. Those duplicate records are generated from some individuals who forgot their log-in account information and opted to create a new account, and others who simply forgot they had an account. With the sense of urgency to secure a vaccination appointment, consumers are moving at a rapid speed and simply want to grab a spot with the quickest credentials available. Regardless, multiple registrations for a single patient will create duplicate patient information. Duplicate records are not only costly (the estimated cost of remediation is $96 per duplicate pair), but they are an incredible drain on staff productivity, and ultimately, they are detrimental to patient safety. Multiple records of a single individual pose a risk for potential allergies, reactions, medical history and more. Even more, it is detrimental specifically to the efficacy of the vaccine as it will be harder to gauge in real time how many patients have been vaccinated, and at what stage, and make it more difficult to truly understand what percentage of the patient population has actually been vaccinated. UIM: not another stop-gap solution Experian’s Universal Identity Manager (UIM) platform is tailor-made for a situation like this as it was developed to create a single view of the same patient with their most current information. The matching technology accurately identifies patients and matches records within and across disparate healthcare organizations, providing a more complete understanding of who a patient is, despite the data gaps or errors that may exist in patient rosters. With it, providers are not only preventing duplicate and overlaid patient records but UIM can also minimize errors and fraud in patient records. It additionally improves staff productivity by decreasing the need for record reconciliation—a benefit likely welcomed by many if they are continuing to see anywhere near 1,800 duplicate records per day. When integrated with a solution like Precise ID, providers can both reconcile duplicate records, and effectively stop them from being created in the first place. By automating the patient portal enrollment process, healthcare organizations can remove the manual processes associated with portal enrollment, optimize critical IT staff resources while securing patient information and support a positive patient experience. State-of-the-art identity proofing, risk-based authentication and knowledge-based questions help providers securely verify each patient’s identity as they enroll for the patient portal. Explore how Experian Health can help resolve and enhance identities as part of the vaccine management process and beyond, not only by resolving duplicate records, but also by enhancing records with the best demographic and social determinants of health data available.
How has the pandemic affected consumer attitudes around patient access? What do consumers want when it comes to accessing care? These are the questions providers must answer if they are to survive the pandemic and lay the groundwork for future financial success. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. Wherever you are in the digital patient access journey, there\'s an opportunity to improve the experience for patients to one that will not only survive the tumult of the pandemic, but also thrive in the years ahead.
There is no shortage of data in the healthcare industry. Unfortunately, more data doesn’t always mean better data – especially when it comes to patient information. A unique patient identifier (UPI) is a method for standardizing patient identification. Individuals are assigned a unique code, and that code, rather than a Social Security Number, name, or address, is what is used by healthcare organizations to identify and manage patient information. A standardized code like this not only protects sensitive health information but supports the exchange of data between healthcare organizations and states as it is a number and format easily read and recognized by all. While a UPI has yet to be nationally recognized and implemented, a foundation has certainly been made and the industry is perfectly poised to move forward. How a unique patient identifier is used in healthcare The UPI helps healthcare organizations link the right records together, preventing duplicate records from being created. There are many ways duplicate accounts or variances can occur: address differences, name variations, maiden names and even user entry error. With UPIs, providers and payers can link records together and have one complete record and view of the patient or member, ultimately leading to a better experience and increased patient safety. Without reliable records, patient safety takes a hit. Misidentification can contribute to incorrect treatments and adverse medication interactions that have had life-altering or fatal consequences. The UPI’s ability to achieve accurate record match rates for every patient and member also improves efficient, patient-centered care coordination, as well as population health management strategies, prescription drug monitoring programs (PDMPs), social determinants of health and more. It is important to note that the UPI is not a patient-facing number and is not known to the patient or provider. It does not collect or share any clinical claims or diagnostic information; its purpose is simply to link records together giving providers and payers a complete view of someone’s identity. The patient experience within a real network A healthcare organization’s ability to manage patient data is apparent from the beginning. An inadequate system can force patients to fill out forms they’ve already filled out multiple times or undergo duplicate tests as they travel between facilities. It can also confuse patients who have similar information, such as first and last names, during the identification process. In an ecosystem built around a strong healthcare network, these discrepancies can be avoided. Patients are given a unique identifier that remains consistent across every healthcare facility they visit, from physicians’ offices to hospitals, pharmacies, specialists, long-term care facilities, and more. All providers that patients visit know exactly who they are. And it isn’t just greater comfort and convenience that patients gain from a well-connected healthcare network. Managing patients and their data is vital for reducing medical errors. One Johns Hopkins study found that medical errors account for more than 250,000 deaths annually in the United States. Healthcare efficiency within a real network The challenge of managing patient data across the entire healthcare ecosystem isn’t new — interoperability has been a hot button issue for years now. While there are several master patient indexes that organizations can use to match patients with appropriate demographic data, these still include gaps, overlaps, and outdated patient information. These indexes can’t keep up with simple things such as name and address changes or data entry errors. Therefore, providers and payers who rely on them have trouble matching their patients and members accurately. A more effective solution involves combining these data sets to create complete identities and profiles, where every piece of new data is instantly updated and verified. For example, if a provider has a patient in their EHR twice under two spellings of the patient’s name in error, a UPI would link those two profiles, creating a singular view of the patient in that provider’s system. Similarly, a UPI can help facilitate interoperability between healthcare providers. For example, if a pharmacy has a patient listed under a maiden name but the doctor has that same patient under a married name, the prescription during the ePrescribing process might not get associated with the right profile. If both organizations have the UPI on record and submit it during the transaction, the systems will match the patient using the UPI. Every authorized care team member can immediately access the updated data related to a patient or member’s identity, which offers benefits far beyond treatment. For providers, this could mean increased collections. For payers, it could look like improved medication adherence. For example, ValleyCare Health System in northern California was struggling with hundreds of bills being returned each month because of wrong patient addresses. When the health system implemented an identity verification program, it decreased the amount of returned mail by 90 percent. The network effect in a nutshell Sorting through clinical data issues takes up a great deal of time. The administrative costs of healthcare account for nearly 8 percent of U.S. healthcare expenditures. By identifying patients through unique socioeconomic factors, healthcare organizations can more efficiently and accurately manage data and put it to good use. A healthcare network tied together by streamlined data management provides an environment where duplicate or inaccurate information is detected and corrected almost immediately. Both patients and members are accurately identified, and their data retains its quality at every stage of care. When combined with other patient engagement solutions, such as patient portals, data and identity management tools create the infrastructure needed for healthcare to truly become one cohesive, patient- and member-centric network. Unique patient identifiers in the news Until recently, the use of federal funds for the adoption of a national patient identifier (NPI) was prohibited. The ban has limited the Department of Health and Human Services (HHS) from interacting with healthcare organizations to develop and implement an NPI strategy. In the years since the funding ban put the brakes on a universal approach, many disparate software solutions have been created which don’t talk or share information with each other. Integrating these systems in an industry of this scale will take a concerted effort. The ban was lifted in July of 2020, giving HHS the ability to evaluate a full range of patient matching solutions and enable it to work with the private sector to identify a solution that is cost-effective, scalable, secure and one that protects patient privacy. Karly Rowe, Vice President, Patient Access, Identity, and Care Management Products at Experian Health believes that “private-sector entities have already developed the technological foundation for data interoperability through the creation of UPIs that are maintained in a master person index.” These solutions are vendor neutral, meaning data can flow freely between disparate electronic health systems, regardless of size or location. With federal funding back on the table, “UPIs could be adopted with government oversight of private sector offerings and the creation of national standards to ensure quality patient matching and identification.” At the end of 2019, Experian Health announced that every person in the United States (about 328 million Americans) had successfully been assigned a unique UPI, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”). Combining Experian’s expansive data assets and innovative UIM technology along with the unique ability NCPDP brings to share the UPI throughout the healthcare ecosystem using the NCPDP Telecommunication Standard and its SCRIPT Standard, each individual in the U.S. that has received medical care or utilized a pharmacy has been processed through the solution and assigned a UPI. As new patients enter the healthcare ecosystem, this number will continue to grow. Learn more about unique patient identifiers Having a single, unified and accurate view of patients and members is a challenge that plagues the healthcare system. Now, there is promise of a comprehensive solution that reduces the barriers to make healthcare safer. Interested in learning more about unique patient identifiers and how Experian Health can help?
Health plans have been fighting against inaccurate member data, incomplete member profiles and duplicate records for years. Without a watertight way to keep track of patient identities so health data is reliably linked and accessible across multiple services, payers can’t always be confident that the record in front of them matches the member they have in mind. The pandemic has brought this into sharp focus: positive COVID-19 test results aren’t always following members from service to service, and as the vaccination program rolls out, knowing who has had the disease and who has been vaccinated could be difficult to monitor. As health data expands exponentially and the need to share and connect member records becomes more urgent and complicated, the challenges facing health plans will only grow. Could a unique patient identifier (UPI) be the answer? 4 member matching challenges that health plans could solve with a UPI 1. The healthcare ecosystem lacks 21st Century Cures Act data coordination The lack of integrated systems to transfer member data securely contributes to safety issues, payment delays and potential audits and fines. Over a third of denied claims for health systems result from inaccurate patient information, costing them at least $6 billion per year. While this would seem not to impact the payer, the inability to properly link claims to members could lead to an inability to understand the risk represented by the members being covered. Or worse, an inability to anticipate and monitor trends in members health and provide proactive healthcare options. A unique patient identifier can connect the dots between different parts of the healthcare ecosystem so duplicate and incomplete member data can be detected and eliminated. With a more complete picture of who a member is, health plans can make decisions based on accurate information and exchange data safely and securely. There’s a far lower risk of acting without knowing about recent treatment or test results, or communicating using the wrong address (or even to the wrong member). 2. Healthcare providers have outgrown traditional matching tools With the volume and variability of health data to be matched, traditional matching tools are no longer fit for purpose. For example, an enterprise master patient index (EMPI), which links all versions of a patient’s record across several facilities, may seem reliable. However, by relying on a single source of demographic data, EMPIs likely replicate errors and outdated information, and may combine records for patients who share certain demographic information (for example, if two patients have similar names and the same date of birth). Instead, payers should consider a matching solution that combines member roster information with comprehensive third-party reference data. Member records are matched using referential and probabilistic matching, and connected using a UPI. This gives health plans a more complete picture of their members, built on reliable health, credit, and consumer data sources, and allows all parties to understand the person at the center of it all. 3. Discrepancies in member data make care coordination impossible Members may use different names or nicknames, their address may change, and they may even share a Social Security Number (SSN) with someone else. How can health plans help to coordinate care if they’re not sure they’re tracking the right member? A single electronic health record (EHR) can follow the member throughout their healthcare journey with a UPI, so health plans can be confident that the person on the phone or in the office matches the record on screen. They can monitor and respond to gaps in care, allowing them to better coordinate care for better patient health, improved member engagement and money-saving operational efficiencies. 4. Members present to multiple facilities, inhibiting care plan tracking How can health plans reliably track medication adherence, especially when members present to multiple locations? Is there really a gap in care, or did the member just attend a different facility? And if members go to different pharmacies, how can a pharmacist be sure the prescription is going to the right person? All of this can create risks to patient safety and increased costs for payers. A UPI can help. Experian Health has teamed up with the National Council for Prescription Drug Programs (NCPDP), which sets standards for pharmacy services to exchange electronic healthcare data. A framework has been built for a UPI-based patient matching solution that the entire US healthcare network can use. Not only will this improve patient safety, it’ll minimize staff time spent on reconciling incorrect records, thus boosting financial performance too. When it comes to mismatched records, prevention is better than cure. With a Universal Identity Manager, health plans can have confidence in the accuracy and security of the data they’re using and sharing, promote patient safety, and improve staff productivity. Contact us to learn more.
Experian Health products referenced in this blog post: Patient Engagement Solutions Patient Scheduling Precise ID Patient Payment Estimates Patient Payment Solutions To access more insights and trends, download the entire white paper: How has the pandemic affected consumer attitudes toward patient access? What kind of digital experience do consumers expect from their healthcare provider in 2021? Are patients and providers on the same page when it comes to self-service in the healthcare journey? Providers must answer these questions if they are to improve their digital front door, boost patient loyalty and withstand the financial impact of COVID-19. While we know that a satisfying patient access experience translates to a stronger revenue cycle, change can feel risky without knowing what consumers really want. Experian Health surveyed hundreds of healthcare consumers and providers to find out what each expects from patient access in 2021, and uncovered opportunities for providers to lay the groundwork for future financial success. Survey findings: 4 revenue-boosting opportunities for patient access in 2021 1. More control and convenience for consumers Nearly eight in ten consumer survey respondents want to be able to schedule their own appointments, at any time of day or night, from their home or mobile device. They can already order groceries and view their bank accounts this way – and they want the same level of control and convenience when managing the non-clinical aspects of their healthcare. Digital patient engagement solutions allow providers to offer consumers the flexibility and accessibility they crave. Patients can schedule appointments online, complete registration from home and pay bills from a mobile device. Convenience also delivers health benefits: no-shows are less likely, and patients find it easier to adhere to care plans. And while COVID-19 remains a concern, self-service options minimize face-to-face contact, keeping staff and patients safe. Automating patient access even contributes to better collection rates, for example, by reducing errors that can lead to denied claims. 2. But don’t deliver convenience at the expense of safety and security Patients want convenience, but they also want their data to be kept safe. More than half of consumers surveyed, particularly the younger age groups, say they worry about security when accessing their personal details online. Security can be challenging for providers: they need multi-layered solutions that can adapt to security threats that evolve with ever-increasing complexity, without creating cumbersome log-in processes for patients. But with the right technology, providers can safeguard patient data with confidence. Experian Health’s patient portal security tools use leading-edge identity proofing, risk-based authentication and knowledge-based questions to reliably verify patient identities. Patients can book appointments, register for care or view their health information. Calls to IT support are likely to drop too, saving staff and patients valuable time. 3. Contactless care requirements are driving long term, systemic change While many of these changes were already simmering in the background, the pandemic has turned up the heat and accelerated the need for contactless care. Will this be a long-term trend? Both patients and providers believe self-service technology is here to stay and seven in ten providers surveyed say they don’t expect patients to feel comfortable in waiting rooms until at least summer 2021. While face-to-face care will always be important, it seems likely that a digital front door will become the default to make the non-clinical portion of the healthcare journey easier and quicker for everyone. “As providers expand the use of patient portals, there is a huge opportunity to demonstrate the true value of virtual care – and transform healthcare for the long-term.\" - Tom Cox, general manager, head of product, Experian Health 4. The financial conversation between consumers and providers must be based on trust, transparency and empathy When the final bill bears no resemblance to initial estimates, patients feel frustrated and misled. With deductibles and out-of-pocket expenses on the rise, patients are demanding simple and clear pricing information so they can plan accordingly. Providers that offer consumers transparency, understanding, control and convenience when managing their financial responsibilities are going to have the competitive edge. Providers can achieve this with clear, upfront and accurate pricing estimates to help patients understand their financial obligations before their visit. Next, support to check coverage and advice on tailored payment plans will provide patients with as many tools as possible as they plan to meet those obligations. Experian Health’s Patient Payment Solutions can check for patient coverage, identify a payment plan(s) that suits a patient’s individual situation, and then make it easy to pay via a mobile device. Future provider revenue hinges on investment in digital healthcare. A welcoming, convenient and secure digital front door translates to patient loyalty, which in turn can mitigate losses in challenging times. Wherever are in digital patient access journey, there’s an opportunity to improve the experience for patients and build a revenue cycle that not only survives the tumult of the pandemic, but also thrives in the years ahead.
As 2020 draws to a close and headlines hint that the end might finally be in sight for the pandemic, the healthcare industry is considering COVID-19’s legacy. The sudden shift to contactless care, financial consequences of widespread social distancing measures and changing expectations of the patient experience have upended the world of healthcare and health IT – but which changes are here to stay? And what do these changes mean for the patient experience in 2021? We asked several leaders across Experian Health for their predictions in the areas of patient access, collections, and identity management, and here is a preview of what they had to say: “Patients will choose providers that give them control over their healthcare experience” Patients have more opportunity today than ever before to manage their healthcare experience from the comfort of their own home, whether that be through patient portals, online self-scheduling and registration or online payment tools. As lockdowns and social distancing prevented patients from presenting in person, providers were forced to offer patients with more options for self-service. Unsurprisingly, this was a move a lot of patients have been waiting for and many welcomed this new technology with open arms. Jason Kressel, senior vice president of consumer products and analytics at Experian Health, expects that, as patients become more accustomed to this level of self-service, more than half of consumers will change providers in favor of one that offers premium digital healthcare services: “Providers who can meet patients where they are—through web-based services and via their mobile devices—will have the most success with retaining and attracting patients.” Online self-scheduling can put patients in the driver seat while also avoiding unnecessary contact while many remain cautious about on-site visits. With access issues removed, the patient experience will improve, in turn improving health outcomes (and providers’ bottom lines!). “With hospital finances on shaky ground, collections will be a top priority for survival” As COVID-related unemployment leads to an unstable insurance landscape, many providers are worried about maintaining effective collections processes, and they cannot afford to spend time chasing payments. Guarding against uncompensated care and tightening up the collections process will be essential. Automated collections software can help collections teams focus their efforts on patients who are most likely to pay, while also helping patients manage their financial obligations with as little stress as possible. Providers can also quickly determine which patients qualify for financial assistance, helping them get them on the right payment pathway for their circumstance without delay. Not only will this provide a much better patient financial experience, it’ll prevent “lost coverage” and allow providers to collect a larger portion of dollars owed. “The surge in portal usage means providers need to watch out for fraudsters” What does the rapid growth in portal uptake mean for data security? The speedy rollout of telehealth and other digital services has exposed security concerns for many providers, who fear a rise in fraudulent activity in 2021 as cybercriminals sniff out opportunities to steal patient data. To protect patient information and avoid costly reputational damage, providers must adopt more sophisticated identity management solutions. By combining cutting edge identity proofing, risk-based authentication and knowledge-based questions, providers can more easily verify a patient’s identity when they log on to their portal, greatly eliminating the risk of fraud. Interested in learning more about other trends that could affect the patient experience moving forward?
