First Pst after migration to Cloud in Health care Blog

The number of uninsured American adults has been rising steadily since 2016, reaching a four-year high of 13.7% in the last quarter of 2018. The challenges have been well-documented: low levels of health insurance contribute to health inequality, poor population health, and worse outcomes for individuals as people hold off seeking care. For providers, a growing uninsured population usually leads to an uptick in uncompensated care and a hefty blow to their balance sheet. Affordability is the main driver of this trend (due to rising premiums and tighter household budgets), but a big part of the problem is simply confusion around who is entitled to what. People may have coverage they don’t know about or have forgotten. Media reports and reduced outreach for Obamacare have left many wondering whether support from public insurers is even still available: a Kaiser Family Foundation study in 2018 found that around a third of Americans believed or weren’t sure if the Affordable Care Act had already been repealed. No wonder fewer people are signing up. Finding missing coverage is a challenge for most providers, but with the right discovery strategy, it’s possible to drive down the number of accounts ending up in bad debt collections or written off as charity designations. Top-performing providers use a four-part strategy, encompassing the following: 1. Look beyond self-pay patients For most healthcare providers, the search for missing coverage usually focuses on self-pay patients. In fact, many Medicaid, Medicare and commercially insured patients also have unknown additional coverage. Unearthing this secondary and tertiary coverage can help ensure the full amount is paid. Jason Considine, Senior Vice President and GM of Patient Experience at Experian Health, says: “Finding missing secondary or tertiary coverage for patients with Medicaid or Medicare can help hospitals capture the full amounts they’re entitled to and reduce the risk of revenue loss. Hospitals can claim against any balances not covered by public payers, but only if they look for additional coverage.” This means hospitals shouldn’t focus solely on scrubbing self-pay accounts. By searching additional commercial coverage and combing through Medicare and Medicaid coverage, you might be surprised at the level of reimbursement available for amounts that would otherwise have been written off. 2. Perform coverage checks as soon as possible The sooner you check for coverage, the sooner you can verify the accuracy of the account – and the sooner you can get paid. Essentia Health in Minnesota implemented a coverage discovery strategy that ran comprehensive coverage checks throughout the whole patient process. Patient accounts were scanned before they received care, then again at the time of service. Finally, searches for active insurance were performed 30, 60 and 90 days after service. Kathryn Wrazidlo, Patient Access Director for Essentia Health, says: “We found 67% of coverage for patient accounts that were self-pay or uninsured at the time of pre-service, and 33% at the time of post-service. This has helped patients because we’re actually billing their insurance versus billing them for self-pay. It’s helping staff because they’re billing the insurance company much quicker. There’s less rework. We’re decreasing the amount of time the account is sitting in AR by billing much sooner in the process.” 3. Access the widest possible datasets The whole point of the coverage discovery process is to track down coverage your patient doesn’t know about. So why would you limit your search to what they can tell you? Equally, searching through payer databases within what are often very limited search parameters can be a painstaking process. A more logical approach is to use a search strategy that covers historical data, demographic information and multiple proprietary datasets to cross-check patient accounts for previously unknown coverage. A tool that offers weighted confidence scoring and discrepancy checks can further reduce the risk of false positives and errors. With this approach, Experian Health’s Coverage Discovery tool analyzed more than 16.6 million accounts and found 3.6 million coverages, resulting in $5.8 billion billable charges found in 2018 alone. 4. Digest the data with reliable reporting tools Of course, checking more accounts and accessing wider datasets means you’re going to have far more data to handle. Automated scrubbing tools, quick-look dashboards and reporting software can give you instant access to the information you need. Working with a reliable partner can help you sift the data for additional coverage, and also provide insights into ways to boost workflow efficiencies and make life easier for your team too. Wrazidlo says: “We use the power reporting that’s offered with the Experian product and we also do reporting internally. The reporting helps us know whether the product is working for us or not. We can see how much we are recovering… My staff really enjoy using it.” Find out more about how Coverage Discovery could help you find additional coverage more easily, so you can get paid sooner and in full.

Any kind of identity mix-up is disturbing, but when it occurs within the healthcare system, the fallout can be severe. At best, misidentifying patients leads to lowered consumer confidence, but at worst it can compromise a person’s essential medical treatment. As a healthcare professional, you want to be absolutely certain that comprehensive and correct data is associated with each person who comes in for care, and that you’re utilizing the most advanced measures to make it happen. Universal patient identifiers are an integral part of that goal.  Patient Safety Awareness Week is the perfect time to convey that message clearly and positively. What is Patient Safety Awareness Week Patient Safety Awareness Week, organized by the Institute for Healthcare Improvement, is an annual recognition event dedicated to boosting the public’s knowledge about health care safety. In 2020, it runs from March 8th to the 14th. Patient Safety Awareness Week is your ideal opportunity to proactively inform and reassure patients of your commitment to safety. New systems, such as universal patient identifiers (UPI) developed by Experian Health, were created to ensure that patient demographics are as complete and error-free as possible through patient matching. Impact of patient identity problems Many patients may already have concerns about their records, having heard about problems from the news, friends or relatives, or have personally experienced identity misidentification. According to an ECRI Institute report, approximately 30% of the patient data that’s held in electronic health records is either incomplete or inaccurate. So how bad can the damage of patient misidentification be? The Ponemon Institute reported that roughly 86% of all clinicians witnessed a medical error that was caused by patient misidentification. And most disturbing: a study by the National Institutes of Health discovered more than half of all the deaths attributed to medical errors are a result of identity errors. Identification mistakes don’t just lead to unnecessary patient suffering either. These unforced errors undermine the very foundation of healthcare organization: trust. The organization that makes them suffers a serious blow to their brand. How patient identity mistakes are made Human error has been most often to blame for patient identity mistakes. Every day, healthcare providers handle an astonishing influx of information, as hundreds of thousands of electronic patient records flow in from a vast number of different systems and departments. All the while patients’ names and addresses change, which in turn requires updates. Inputting all that data manually is a major challenge, and inconsistencies typically occur in the data entry process. In fact, the National Center for Biotechnology Information found that the greatest proportion of mismatches are centered around a patient’s middle name and their Social Security numbers. Misspellings and entering first, last, and middle names into the wrong fields are also common. Once identity mistakes are entered, a patient can have duplicate records and disparate facts, matching past diagnoses and prescribed medications. Billing problems, too, can result. A patient’s statements might not be sent to the correct mailing address, resulting in them experiencing unnecessary credit troubles. Solutions to identity problems In order to consistently and correctly match patients with their medical records, innovative technology has been developed. UPIs use Experian’s consumer demographic information and methodologies to identify record matches and duplicates in a patient’s file. Once a unique UPI is created for the patient, the potential for identification mix-ups is vastly reduced. More, UPIs lead to efficiencies that drive costs down for all concerned. It’s expensive and laborious for healthcare provider employees to record and update such a high volume of patient data by hand. Rectifying mistakes is not only time-consuming, it can cause insurance issues to arise. Certainly, obtaining the best treatment is paramount to patients, but keeping healthcare costs to a minimum is also important. 79 million Americans are struggling with overwhelming medical liabilities, found The Commonwealth Fund. However, a survey conducted by Black Book found that patient matching discrepancies can lead to nearly $2,000 in extra inpatient costs per person. No one should pay more than they have to for their healthcare, and UPIs can make sure bills are appropriately assessed.  For this year’s Patient Safety Awareness Week, spread the word to your patients that measures have been put into place to protect their identity. As of the end of 2019, every person in the U.S. has been assigned a UPI, and correct and complete information will be associated with each patient. Everyone should be aware that you are taking steps to ensure the accuracy of their medical records — which keeps them safe and their financial obligations down.

Recovering underpayments from commercial insurers costs the healthcare industry billions every year. When payments come up short against what the provider expects, it’s not just the missing revenue that puts a dent in the bottom line – the staff time spent on reprocessing bills takes an extra bite out of the organization’s margins. Underpayments can be attributed to confusion around changing payer policies, inadequate claims data and simple human error. But when providers are focused on creating the best possible patient experience, keeping track of payer behavior is a task that’s easily crowded out. Unfortunately, failing to spot underpayments or keep tabs on those policy changes could lead to bigger revenue loss further down the line, in the time-suck that is collections recovery. From the payer’s perspective, it can be hard to understand why providers don’t just fill out claims according to the agreed rules. For providers, those rules seem to be in constant flux and different for each insurer. Ultimately, it’s a lack of communication that’s at the heart of the problem. Clean claims are only possible when payers tell providers exactly what they need, and providers have the systems in place to deliver that and check that payers are themselves following those rules. Within the industry, we already measure so many aspects of the revenue cycle, but are we paying enough attention to the payer-provider relationship? Is communication the missing metric? Three essential ingredients for a healthy payer-provider relationship Managing payer contracts can often be time consuming, complex and costly. Many healthcare providers are focusing on three strategies to help build better relationships with their payers, to take the stress out of this process and ensure they get reimbursed quickly and fully: Better communication. When you’re clear about what your payers need, you can make sure all your staff and systems are set up to deliver that. It’s impossible to fix the sticking points in your claims processing if you don’t know where they are. With a method to support better communication with payers, you can negotiate contracts that better suit both parties, keep track of changes to payer policies and move quickly when payers aren’t holding up their end of the bargain. You’ll know when a payer has made a payment at an out-of-network rate or reverted to rates in a previous policy and you’ll have the data your payer needs for a quicker recovery process. Two-way accountability. One way to build a better relationship with your payers is to hold each other accountable. Providers need to have systems in place to be able to hold payers to account for underpayments, but also to hold themselves to account for under billing. With a robust contract management tool, you can monitor payer compliance with contract terms and clarify what’s expected on your side to ensure you submit clean claims every time. Efficient processes: When the payer landscape is constantly changing, you need to have solid workflows to manage your claims processes as efficiently as possible. Automation and software solutions can help you minimize staff time spent manually checking payer policies, as well as generating the data you need to challenge underpayments. With a dashboard showing you real time claims data all in one place, your team will be able to identify, discuss and resolve queries with payers much more quickly than with disparate manual systems. How better payer monitoring saved one practice group $3.5 million in a single year In 2007, UCLA Health System Faculty Practice Group (UCLA FPG) saw $4 million go uncollected, largely down to difficulties tracking payer contracts. As the volume of payer contracts grew, it was harder to catch underpayments and manage the recovery process. Measha Ford, Director of Revenue Integrity at UCLA FPG says: “Before using Contract Manager, we didn’t have a method in place to track under and overpayments so there was a lot of lost revenue.” Without an efficient system in place, it was extremely challenging to manage collections data, monitor payer performance and spot when claims were being paid at out-of-network rates. This put UCLA FPG in a tough position to try to negotiate the best possible contracts with payers. By implementing an automated system, UCLA FPG could keep a closer check on payer contracts, eventually sustaining a recovery rate of 80% and recouping $3.5 million in one fiscal year. The data collected has not only helped to build a more predictable revenue cycle, but also supports more strategic decision-making when modeling new and amended contracts. And for Measha and her team, being armed with up to date, reliable data makes managing the relationships with payers so much easier, saving them time and effort that can be better used elsewhere. Find out more about how Experian Health Contract Manager can help you create friction-free interactions with your payers.