First Pst after migration to Cloud in Health care Blog

It's no secret that claim denials cost healthcare organizations. They take about 16 more days to pay out than claims that have not been denied. On average, this delay in payment equates to one percent of a healthcare organization’s cost structure.   Final claim denials — or claims in which the payer never pays the provider — lowers a typical hospital’s annual net revenue by 1.9 percent. These tack on additional administrative costs because of the work it takes to close them.   The good news is that 76 percent of claim denials are eventually paid off — but the staff time it takes to get the payments can be costly.   Claims roadblocks   Experian Health recently worked with a large healthcare organization that manages more than 200,000 claims per month, which exceeds $1 billion in claims dollars. The organization has almost 50 hospitals in its network, as well as urgent care and cancer care centers, which creates a large number of transactions and claims to process. This includes Medicare, Medicaid, private insurance, worker's compensation, managed care, and more.   Before partnering with Experian Health, a number of errors were leading to denied claims, including discharge-not-final-billed errors, claims errors, stop bills, late charges, clearinghouse edits, and other factors that created roadblocks. But claims automation helped turn things around.   Automation reduces errors   Automation provides benefits to healthcare organizations and patients because it speeds up evaluation, ensures correct and timely billing, and reduces the number of manual touches needed for each claim.   According to the Council for Affordable Quality Healthcare, manual processes slow down claim reimbursement. People take an average of four minutes to process claims, but automation reduces this to three minutes.   Although a minute doesn't sound like much, it translates to thousands of hours saved for a healthcare organization that processes 200,000 claims each month. Automation also frees up time for billing teams to focus on more pressing tasks.   How organizations can benefit   By automating, this healthcare organization could ensure clean claims by utilizing an expansive library of national payer edits and implementing custom edits. This eased the follow-up process because teams had detailed insight into claims status, an analysis of denial reasons to efficiently process them, and automated workflow and payment posting to handle splits and contractual adjustments.   One of the biggest reasons this healthcare organization partnered with Experian Health was the ease of implementation with its medical records system, Epic. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, found and repaired issues with the system build, and created opportunities for cross-training and centralized reporting.   Long-lasting results   Through this automated process, the healthcare organization now has detailed insight into its claims management process and can monitor rejections data, review effectiveness, and find ideas for even more system automation.   Through its partnership with Experian Health, this healthcare organization has improved its claims metrics across the board. It improved its acceptance rate by 10 percent, and it became an Epic top performer for claims acceptance, averaging a 99 percent acceptance rate. It has also increased its clean, paid claims percentage by over 10 percent.   Start automating to streamline your claims process.

Chalk it up to the rise of high-deductible plans or decreasing payer reimbursements, but the numbers don’t lie: patients are footing more of their healthcare bills and hospitals are struggling to collect. In fact, a recent TripleTree report revealed there has been a 69 percent increase in consumer payments due to providers over the past four years. That same report also noted providers collect only 1/3 of patient balances larger than $200, with the balance being sent to collections or written off as bad debt. All this to say … collections can make or break a hospital. So, how are hospitals compromising on their collections game? Let us count the ways: 1. They treat all patients the same. Some patients may be able to cover all their care costs up front, while others need to spread out payments, or perhaps get help from a lender or charity. Logical, right? But for some reason, many hospitals take a one-size-fits-all-approach to their collections work. They’ll simply submit the bill, wait for payment and see what happens. If payment fails to come in after repeated attempts, they send the account to collections, and the agency often takes a similar approach. Scoring and segmenting patient accounts based on who has the propensity to pay –and directing them to the in-house or outsourced team most likely to collect – is a much more productive collections strategy. Even better, providers should try to determine what patients owe before a procedure, and reveal payment plan options from the start. By developing a means to estimate the cost of a patient's care, providers can deliver a figure to target for pre-operative, pre-procedure collection. 2. They lack an agency strategy. Just as hospitals can take one-size-fits-all approach with their patient collections, so too can be the case with their collections agencies. Some hospitals find themselves struggling with how to reconcile accounts placed with their agencies. Others are unhappy with their early- or late-stage collections vendor, but can’t quite pinpoint where it’s all going wrong. Advocate Aurora Healthcare, an operation with 27 hospitals and 500 outpatient locations, was trying to oversee 20 different collections agencies just a few years ago. They wanted to reduce the number of agencies doing their collections work, and gain a clearer understanding of who was performing best, but they lacked the data insights to evaluate. By tapping into a collections optimization platform, Advocate Aurora was able to reduce their agencies from 20 to four, and they started seeing double-digit increases in their patient collections. Routing accounts to the optimal collections resources, and using collection agencies judiciously, minimized their collection costs, and helped them stay focused on patients who can and will pay. 3. They rely on limited data sources. To create a truly effective collections strategy that is both predictive and insightful, hospitals need to rely on data sources that offer breadth and depth. Let’s consider an example. In the credit world, financial services companies can be looking at two consumers with identical credit scores and come to the conclusion that they should treat each the same. But with more data insights, a lender might see that one is trending up, making on-time payments that exceed the minimum balance, and the other is trending down, showing signs of payment distress. With historical data and other insights, the financial lender would likely treat each of those individuals differently. Agree? The same scenario can unfold in the healthcare space. If providers are solely looking at zip code data, or historical healthcare data, they will be challenged to offer personalized payment plans and decisions around how best to collect. Combining various data sources, including credit data, can provide hospitals with deeper insights into a patient’s propensity to pay and financial disposition. This allows healthcare organizations to identify the best financial pathway for each patient at, or before, the time of service, and will ultimately optimize their account receivable performance as well. — By flipping the switch on a few of these strategies, hospitals can turn their patient collections game around. They’ll see gains in patient satisfaction, improvement in the accounts receivable bucket and the power data can have on segmentation. There’s really no excuse to fail.

The healthcare industry is starting to embrace the use of consumer data to help achieve better treatment outcomes, engage patients in meaningful ways, market to health consumers, and identify social determinants of health among their patient population. As consumers now spend an estimated $3.5 trillion annually on healthcare in the U.S. (approximately $10,348 per consumer), they expect the healthcare industry to create modern and innovative experiences for their care journey. Those experiences can only be created through data-driven insights. When it comes to the world of data, where can we start? What if we could use health data and other variables like socioeconomics to predict missed appointments, noncompliance with medications, and patient trajectory over time? By learning how to apply data analytics to practice management workflows, we will improve the delivery of patient care by zeroing in on the best in social determinants of health. Data insights can also forge stronger customer and patient relationships, foster brand loyalty, and drive decisions around how to interact with consumers in ways that consider their lifestyles, attitudes and preferences. Those insights help deliver tailored messages to patients that are relevant to every stage of their journey. And what about applying credit data to create a personalized, nearly invisible, payment experience for patients? As patients express that paying their bill is a top pain point in their health journey, we look to use the right data insights to fuel collection strategies by offering patients financial assistance and payment plans at the point of service to ensure a positive patient financial experience. The right data can transform patient and consumer experiences in healthcare. However, it’s important to have access to clean, original-source data, as well as analytics to gain insights that drive decisions and achieve results. Household data, marketing data, credit data and of course healthcare data can all offer a more complete view of today’s healthcare consumer. If you are attending HIMSS19, join us in booth 2033 to hear one of our presentations on using data in the patient experience to earn CE credits.