First Pst after migration to Cloud in Health care Blog

The United States’ health system has become the most expensive in the developed world, and high administrative costs are a big factor. They account for more than 25 percent of spending on hospital care, making American healthcare administrative costs higher than any other country. Much of the problem comes from the complexities of payment. With public health programs, private insurers, and patients themselves all splitting the bill, it’s difficult for hospital administrators to determine who pays what in each situation. Especially during patient registration, they are bogged down by the time-consuming process of verifying patients’ eligibility for insurance and other programs. For these reasons, Martin Luther King, Jr. Community Hospital decided to focus on improving its patient registration process. The private nonprofit safety net hospital in South Los Angeles serves a high-need community and sees about 300 patients per day. Manually checking in all those people meant that MLKCH’s administrative team had an overwhelming workload. The hospital needed an integrated solution. Automation simplifies hospital patient registration The hospital’s staff was spending a significant amount of time checking different payer websites and making phone calls to determine each patient’s eligibility for insurance and various programs. Then, the benefits information had to be copied and pasted into the hospital’s non-integrated platform, which was another slow process that often resulted in inaccuracies. Quality assurance to find and correct those errors was a manual process, too, taking up more of the administrative team’s bandwidth. To free up resources and reduce errors, the hospital wanted to automate its verification processes, streamlining its registration, quality review, and more. MLKCH also needed its hospital patient registration software to work well with the Cerner system it already used. It decided to implement Experian Health’s eCare NEXT® platform. “We decided to use Experian Health’s software within Cerner versus a couple of the products we were looking at, at the same time, because it truly integrated within Cerner,” said Lori Westman, patient access manager at MLKCH. “When we presented this to our CFO, he liked the fact that it was integrated within Cerner; he didn't want us to have to go out to another third-party payer to pull information back. It's all about time and the time we can save on our registrations. That was the biggest selling point — the integration within Cerner and its seamless registrar on the back end. To the team, it's just another program they're working with in Cerner.” The software from Experian Health automates registration and financial clearance, among other patient access processes, which account for up to 80 percent of manual preregistration tasks. The system assesses patients quickly, replacing the information-gathering that staff has traditionally done. For MLKCH, which sees many returning patients, if a patient is already in the system at check-in, eCare NEXT pulls up his or her eligibility automatically when an administrator accesses the account. This saves several minutes, making it a notable patient registration process improvement. The system also eliminates a large portion of redundant tasks. When using the platform to check eligibility with one plan, eCare NEXT also searches for other applicable plans. For example, MLKCH treats a large Medicaid and managed care population, so checking a patient’s eligibility required visits to both the state’s and the health plan’s websites. But eCare NEXT will verify both automatically. Additionally, the fact that eCare NEXT integrated seamlessly with Cerner has improved the hospital’s patient registration process. Because the two platforms work together, patient data has become more accurate and the quality assurance process is less cumbersome. MLKCH was able to implement new QA standards after staff became familiar with the automation tool. The team also found that the enhanced data from eCare NEXT can shape user education and pinpoint areas for further improvements. And while there were some concerns that a new platform would take a long time to adopt, the rollout of the patient registration system was smoother than expected. The administrative team got a robust solution with exceptional support to ensure users have every resource they need. Ultimately, implementing an automation tool eliminated MLKCH’s most time-consuming registration tasks, allowing staff members to focus only on the tasks that needed their attention. This made their jobs easier and more efficient while also reducing training needs and improving compliance. The registration process became much faster. Automating preregistration tasks and eligibility verifications has also ensured MLKCH’s administrators have more accurate eligibility information. This integrates with Cerner to increase the quality of patient records. But the most important benefit of improving the patient registration process has been how it affects patients. These time savings get passed on to them in the form of quicker registration and less hassle proving eligibility. Using eCare NEXT has not only helped the hospital's administrators, but it has also allowed MLKCH to enhance patient service. Westman adds: “We get fewer denials because we're getting true verification data, and our patient volumes continue to increase. So the fact that we can take off two to three minutes, at least, on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” Need to streamline your patient access department? Learn more or schedule a demo with us today.

Healthcare providers should be able to focus on what's important: their patients and the care they need. However, providers and their staff must spend much of their time on administrative tasks. A study by AMA Prior Authorization revealed that providers are spending two business days per week just completing prior authorizations. That doesn't even account for other administrative tasks. Meanwhile, providers rely on more payers and plans than ever before, which is often tied to their clinical performance, and patients are becoming increasingly more responsible for the cost of their care. This is leading to an increase in operating losses per physician of 17.5 percent of net revenue in 2017. Providers must prioritize their revenue cycle efficiency if they want to remain financially solvent in the ever-shifting healthcare field. To safeguard its revenue, Schneck Medical Center in Indiana, the only hospital serving four counties, wanted a way to optimize claims follow-up by identifying and targeting the claims needing attention as quickly as possible. This was especially important because an estimated 10 percent of the population lacks insurance and 13 percent lives in poverty in the primary county the medical center serves. Schneck's goals were to: Ensure denials did not exceed 3 percent of net patient revenue. Achieve the estimated total net preventable denials of $3.2 million or a 2 percent increase to operating margin. Reduce denials by confirming patient insurance eligibility, verifying medical necessity, and obtaining prior authorization when appropriate. Makenzie Smith, director of patient financial services at Schneck, said that industry pressures to reduce healthcare expenses and provide a better patient experience are what drove the healthcare organization to look at the revenue cycle technologies and processes it had in place. A better denials management system The denial management process can be cumbersome, especially for community hospitals like Schneck. It takes up too many resources and far too much time. Schneck was looking for better denial analysis reporting and automation software so it could more effectively manage denials and significantly increase collections. The organization's search led to Experian Health's automated approach to tracking the root causes of denials and identifying the trends in order to improve procedures. The software tool provided a comprehensive solution and allowed Schneck to optimize its claims workflow with remittance detail and analytics. It now helps the medical center identify denials, holds, suspends, and zero pays and uses electronic remittance advice and claim status transactions to identify appeals won or lost with payers. This allows Schneck to identify and target the claims that require immediate attention. The payoff With executive leadership buy-in and support, Schneck created a new, better process for claims denial management by: Reviewing preventable denials with customized queues in real time. Identifying directors with staff responsible for checking a patient's benefits and obtaining prior authorizations. Reviewing all denials over $500 in the revenue cycle department. Establishing a schedule for reviewing denials each month. Schneck's new streamlined process and real-time visibility into denials data has allowed staffers to work on denials more efficiently. The ability to link denials to a specific staff member in a specific department has further streamlined the process. The relationship between the front and back office has improved because both sides have achieved a better awareness of processes. With the right denial analysis and automation, healthcare organizations like Schneck can manage denials effectively and increase collections significantly.

There’s no doubt that identity theft is a concern for any industry that handles sensitive customer information; health care is no exception. In 2017 alone, the U.S. Department of Health and Human Services reported 477 healthcare breaches. Together, they compromised nearly 5.6 million patient records. Without adequate IT security, everything that organizations use to improve patient engagement and the continuum of care – especially patient portals – becomes an open door for hackers. But how do we keep patient data secure without burdening patients? We asked Victoria Dames, Experian’s senior director of identity management, how the healthcare industry is evolving to solve for identity theft, as well as best practices all healthcare organizations can adopt to better meet this growing threat. In the world of healthcare, both patients and providers are understandably hyper-sensitive about the exchange and security of healthcare data. How is the industry arming itself to protect data? Are there any shifts you’ve witnessed in security practices over the past few years? Absolutely! The industry has quickly evolved into leveraging technology to share data between organizations and with their patients, but this does bring inherit risk. Criminals also took notice to this shift, and medical identity theft became one of the fastest growing types of identity theft with a roughly 22 percent annual growth. With this evolution, the industry has tightened up on data access, especially as it pertains to the patient. Over the last five years, we’ve seen the shift to enable technology to help identity-proof patients before granting them access to sensitive information. This used to be a manual process. What are some of the best practices healthcare organizations can adopt to limit instances of medical identity theft? First, organizations must understand where their access points are throughout their ecosystems. With 64 percent of patients citing a privacy issue as a key concern for accessing health information online, they should inform patients that they’re providing secure methods for access to their information. Additionally, healthcare organizations must evaluate how physicians access different types of data and portals. As healthcare caught up to electronic records and systems, portals for e-prescribing also arrived. Given the nature of this use case, providing a heightened NIST level of identity proofing is required. The key is to assess what level of identity proofing is needed at each entry point to keep balance on security and the end-user experience. When you look to the future of healthcare, what types of digital technologies and solutions do you see providers putting in place to prevent fraud and protect patient data? Technology moves quickly and so do we. Identity proofing has seen an acceleration in the use of biometrics at different points of entry throughout healthcare organizations, which strengthens our solution. We are starting to see the use of biometrics, similar to your phone face ID, used more broadly through healthcare in conjunction with existing identity-proofing solutions. Experian achieved the Kantara Initiative certification with adherence to the latest guidelines achieving NIST 800-63-3 IAL2 (National Institute of Standards and Technology Special Publication Digital Identity Guidelines 800-63-3 for Identity Assurance Level 2 (IAL2)). This reinforces our commitment to support clients in authenticating consumers, while balancing a positive experience. Learn more about Experian’s identity management solutions.