First Pst after migration to Cloud in Health care Blog

Whether it’s due to pressure from governing bodies or price-shopping health consumers, many healthcare organizations are being challenged with price transparency efforts. With so many moving parts to determine a patient’s financial liability, how can accurate patient estimates be provided in a timely manner? Giving patients the right pricing information at the right time Like many healthcare systems, Blessing Health relied on various printouts and spreadsheets of price lists from different departments of the hospital to provide patient estimates. Lists needed to be manually updated, and the staff often relied on outdated information. The process wasn’t standardized, and estimates were inconsistent across the enterprise. While Blessing wanted to make sure that patients were getting accurate information, the estimates didn’t consider a patient’s insurance information. Since patients weren’t understanding their true financial obligation, it caused frustration among patients and employees. In today’s competitive environment, it’s important to reduce instances in the patient journey that might cause irritation. A recent report from Trends in Healthcare Payments, notes that patients who are satisfied with billing are five times more likely to recommend the hospital. At a time when hospitals are being asked to do more with less and reduce the cost of care, manual processes and work must be reduced and automated with data to provide accurate information. Patient liability estimation is a complex process of calculating multiple components, not easily available to users, including insurance benefits, charges, contractual adjustments and provider discounts. If hospital staff are manually estimating the processes, they could be using outdated pricing lists which may not include application of insurance benefits, contract rates, and discounts. As consumers gain access to pricing information, health leaders should invest in data-driven technology that can provide consumers with accurate personalized estimates. Most healthcare organizations already have the basic data they need to use automated technology to construct estimates for basic services, including claims data, real-time eligibility and benefits information, payer contracts and charge description master (CDM) information. Blessing Health knew they needed to find a way to advise patients of their financial liability, as well as give staff a tool they could confidently use to request patient payments upfront to increase collections. They wanted real-time estimates that were personalized based on a patient’s insurance and contract information. To do this, Blessing Health reached out to Experian Health to integrate Patient Estimates into their Allscripts® workflow. What to look for in price estimator tools Healthcare organizations should implement price transparency and collection practices that are standardized across the enterprise. A pricing transparency tool eliminates the need for manually updating price lists, and removes the guesswork and tedious manual processes, which often result in outdated, inaccurate estimates. Price transparency software should also include reporting features that give greater control over the process and can be agile in managing transparency initiatives as well as track potential versus actual collections. A price transparency tool should highlight a patient’s financial situation, as well as their propensity to pay, allowing you to optimize your collection strategies from the start and get patients on the right programs. To help reduce traffic to call centers, a price transparency tool should be integrated into consumer-facing estimates that are personalized and available through a web portal or mobile app. Price estimation can help with patient collections Through an automated, data-driven process, Blessing Health is now able to provide personalized patient estimates that are 80 percent to 90 percent accurate. (Inaccuracies result from unexpected tests or procedures.) As a result, Blessing Health benefited from a 58 percent increase in point-of-service patient collections. Based on the cost to implement these services, Blessing Health experienced a 1,200% return on investment. After realizing success on the hospital side, Blessing Health implemented Patient Estimates for their physician group as well. — Learn more about how you can empower the patient financial experience.

A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one.   For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices.   Keeping up with payer contracts   In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex.   The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG's numbers continued to fluctuate until implementing Epic alongside Experian Health's Contract Manager.   Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster.   Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.”   The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials.   Experian Health's team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA's contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes.   Analyzing contracts before signing up   In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It's also able to avoid unfavorable contract terms, as they are easily spotted through analysis.   Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.  

Healthcare organizations have been forced to deal with billing challenges for so long that many might consider the struggle to simply be the price of doing business. Denied claims and contractual underpayments are regular occurrences in the payment cycle. And these issues can cause problems in the rest of the healthcare ecosystem when left unchecked. Fortunately, a robust claim scrubbing solution can reduce costs and speed up reimbursement. Healthcare billing costs can add up quickly. The estimated cost of billing- and insurance-related jobs at one large academic healthcare center ranged from $20 to $215 per patient visit, according to a study published in 2018. For years, the State of Franklin Healthcare Associates (SoFHA) was all too familiar with the challenges of the claims process. In 2010, the organization had to keep 12 full-time employees on its payroll devoted to the correction and resubmission of denied claims. When claims are denied, Crowe reports that it takes an average of 16.4 additional days for a hospital to receive payment. And those delayed payments are costly to healthcare organizations. Without the tools that enable a proactive approach, healthcare organizations' only option is to submit claims and then wait to correct the ones that are denied. SoFHA’s large network of 109 providers included a wide variety of specialties and services, from diagnostic imaging and internal medicine to OB/GYN and family practice. SoFHA needed a flexible presubmission claim scrubbing technology that would identify and correct errors before claims could be submitted. To overcome the obstacles in the claim submission process, SoFHA turned to Experian Health's Claim Scrubber. Claim Scrubber stood out to the group in two ways. The first was the price, as users pay a fixed monthly rate rather than pay for each transaction. The other highlight was the ability to build customized claim edits, which are available to all clients immediately when the tool is deployed. For Amanda Clear, SoFHA’s director of business services, that capability made all the difference. “With Claim Scrubber, I have the ability to go into the system and create my own edits,” Clear said. “Other systems either didn’t accommodate customized edits or required you to call, perhaps pay a fee, and go through a long process.” Plus, Claim Scrubber reduces demands on healthcare provider personnel because the tool comes with around 350 edits maintained by a dedicated content team. Payer-specific edits replace between 60 and 75 percent of an organization’s custom edits right away. Claim Scrubber ensures claims are correct and complete the first time they're submitted. Experian Health regularly updates its system with coding and payer changes. The tool adjusts for coding variances on claims submitted to Medicare, Medicaid, and private insurance companies. It reduces denials and drives down rebilling costs for healthcare organizations. With Claim Scrubber, SoFHA generated a clear return on investment, and the group was able to expedite accounts receivable by 13 percent. Perhaps even more telling was the reduction in full-time claim correction employees that accompanied the adoption of Claim Scrubber — a change that occurred in spite of a growing volume of claims. By auditing claims and spotting errors before submission, Claim Scrubber can ease the burden of claims denials and allow healthcare providers to instead focus on their job of providing the highest-quality patient care. — Learn more about how we can help you ensure all claims are complete and accurate before submission to the appropriate payer or clearinghouse.