First Pst after migration to Cloud in Health care Blog

Healthcare runs on revenue, and claims denials can put a big dent into the budgets of healthcare providers — between 5 and 10 percent of claims submitted by healthcare providers are denied. This adds up to billions ­of lost dollars each year for providers in the U.S.   The good news? Ninety percent of claims denials are preventable when healthcare providers automate revenue cycle functions. In fact, providers could gain an estimated $9.5 billion by automating the claims management processes. And money isn’t the only thing to be saved — companies could also have more time to work on other processes.   The problems facing one Oregon healthcare provider   Monitoring claims and cash flow is difficult for any healthcare organization, as the staff at Summit Medical Group Oregon — Bend Memorial Clinic (BMC) knows. Summit Medical Group Oregon – BMC found its team consistently waiting for payer response, which often forced its overall operations to drag.   After 30 to 45 days of submitting claims, if Summit Medical Group Oregon – BMC did not receive payment, staff members would have to reach out to payers to determine whether they had received the claim. They also had to determine whether the claim was in the process of adjudication, as well as any other steps the staff should take in order to get the claim processed, according to Summit Medical Group Oregon – BMC business analyst Sean Schlappy.   These manual processes not only create lags in claims reimbursements, but also take up a lot of staff time. The Council for Affordable Quality Healthcare found that processing claims manually takes an average of four minutes, while processing automated payments takes an average of three minutes. So Summit Medical Group Oregon – BMC decided to implement software solutions to improve acceptance rates.   The tools used for improvement   One product Summit Medical Group Oregon – BMC implemented was Claim Scrubber, which ensures all claims submitted are accurate before they're sent to the payer. Because it can be integrated with most practice management systems, this service allows employees to set up notifications in the healthcare provider's work queue. It also provides detailed dashboards and reports to quickly recognize trends to improve medical coding and reimbursement rates.   Summit Medical Group Oregon – BMC additionally turned to Enhanced Claim Status, which provides employees with status requests based on the payer’s adjudication time frame, improves productivity, and ensures timely and accurate payments. This tool reduces the amount of time staff members must spend interacting with the payer, and it generates work lists of claims with actionable data.   By transitioning most of its coverage information upstream, Summit Medical Group Oregon – BMC was able to obtain more accurate data during the initial patient introduction and registration. Using this technology, Summit Medical Group Oregon – BMC also improved the patient experience.   Using technology for clean claims   After implementing Enhanced Claim Status in conjunction with other services from Experian Health, Summit Medical Group Oregon – BMC gained a 15 percent reduction in accounts receivable days and volume. And the healthcare organization now has a 92 percent primary clean claims rate, and its claims denial rate has dropped to 7 percent.   Integrating several tools is helping Summit Medical Group Oregon – BMC in the long term, Schlappy says. Summit Medical Group Oregon – BMC has increased payment processing and reduced claims denials, and, most importantly, it's producing cleaner charges.

As of January 1, 2019, thousands of hospitals in the U.S. are being required to post an online list of the cost of their services due to a new requirement by the Centers for Medicare & Medicaid Services (CMS). However, amid growing confusion about which fields are required or what format the list of standard services needs to be in, many health systems feel this new law will only create confusion among patients. One health system described the new requirements as, “It would be like walking into a car dealership looking at a new car, asking the salesman how much the car was going to cost and having them hand you the parts catalog. Obviously, when you have the parts catalog, you don't know what parts are in your car or which ones you're going to use or how much labor is going to go into making the car." While posting the list of prices is required by CMS, some health systems have invested in the needed technology to make it easy for patients to shop online for care. For example, in an interview with Modern Healthcare, El Camino Hospital explains they “launched a consumer self-service tool in May 2017, after about a year of development work with Experian Health. Since then, more than 3,000 people have visited the hospital's website, selected one or more of about 90 medical or surgical services they were interested in, entered their insurance information, and received an instant out-of-pocket cost estimate the hospital claims is 95% to 99% accurate.” Health systems like El Camino Hospital know that patients want to avoid costly surprises, and they should be able to understand their financial obligations upfront, including deductibles and copays. In fact, McKinsey research found nearly three-quarters of participants were worried about healthcare expenditures. Legislative help The new CMS requirement is only one of a few initiatives in the works from a legislative standpoint. In an effort to help patients, some members of Congress are trying to bring attention to the topic. A bipartisan group of U.S. senators in 2018 wrote a letter to healthcare stakeholders and experts requesting information in an effort to learn more about price transparency as they considered possible legislation on the matter. Also in the letter, the senators cited the lack of state laws and regulations requiring healthcare providers to make that information available to patients. More than 40 states were cited by the Catalyst for Payment Reform and the Health Care Incentives Improvement Initiative in 2016 because they were deficient in healthcare transparency legislation. And that same report found that some patients were paying thousands of dollars more than others for the same procedures, depending which healthcare provider they used. Alleviating patient stress Transparency in billing creates more satisfied patients because they know how much they will be paying for services, which makes it easier for them to budget. Going to the hospital is usually a stressful time for patients and their families. An easy way for healthcare providers to alleviate that stress is to help patients understand their costs upfront 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. Experian Health has the technology to help healthcare organizations convert this information into patient costs through Patient Estimates. This kind of transparency provides several benefits to both providers and patients. Online estimates published on healthcare provider websites give patients access to the information any time, including late at night and on weekends. And these estimates can be obtained confidentially, so patients who may be uncomfortable asking about certain procedures can find that information on their own. And that helps them be more relaxed about making appointments and scheduling treatments because they have confidence they won't face billing surprises. This feel-better result of having prices at their fingertips has a clear benefit for the healthcare providers as well. Patients are able to plan and pay for services, decreasing unpaid balances for hospitals and other healthcare providers. Ability to budget for healthcare costs Patients who know what to expect can budget wisely and actively take charge of their healthcare bills. They go in with their eyes open, which leads to improved revenue cycle management. In the end, both the patient and the hospital get what they want. With Congress and state legislatures looking at transparency in healthcare, providers can expect to see more of these rules. Healthcare organizations can get ahead of them with software like Experian Health's Patient Estimates. Healthcare consumers don't like surprises in their billing. Price transparency gives them the information and peace of mind they need to secure healthcare services and be assured that they know what they will be paying for them. Learn more about how Experian Health can help you achieve price transparency for your patients.  

The Vancouver Clinic was facing the same problems that all healthcare organizations grapple with: too many claims denials and too much bad debt. So, Paul Brown, the clinic's chief financial officer, turned to his background in manufacturing technology to see how his organization could find efficiencies. He used his experience and knowledge to inform his and the clinic's roadmap to implement change. The first step was looking at quality. In manufacturing, every step in the process is studied closely and tested to ensure absolute accuracy. Vancouver Clinic did the same. From a patient perspective, it wanted a seamless experience, including making appointments, reducing patient time at reception, ensuring labs were returned quickly, and making sure patients had quick access to any prescriptions they needed. Although the improvements Vancouver Clinic wanted to make originally were seen as a technology project, it quickly became evident that improving the process would also require training for staff and defining performance indicators. However, as technology played a key role, Paul reached out to Experian Health to implement some much-needed automation in the revenue cycle process. One big goal for the partnership was to improve revenue and collections, which is important as U.S. healthcare spending continues to skyrocket. Spending has reached $3.5 trillion, and Medicare bad debt adds up to more than $3.69 billion. Experts predict these numbers will continue to grow, and soon, the nation will spend close to 20 percent of the gross domestic product on healthcare alone. Vancouver Clinic was also grappling with these issues. It had higher-than-average claims denial rates, which cost the clinic $10.5 million each year. It also had higher-than-average bad debt of $3.5 million. The goal was to reduce that by 50 percent, and the numbers are going in the right direction. To get there, Vancouver Clinic took a multifaceted approach to implementing software solutions. One solution was Payer Alerts, which creates authorization updates that reduce errors and inconsistencies before claims are submitted. When they’re detected, the alert format is easy to read and understand so corrections can be made quickly. Other technology solutions included Eligibility, which simplifies the insurance verification process; Payment Safe®, which is an efficient and seamless way to process patient payments; and Claim Scrubber, which helps submit clean claims to payers and reduce claim denials. The results for Vancouver Clinic were quick and dramatic. Claims denial rates dropped more than 30 percent. The denial rate, which was around 14 percent, is now under nine percent. Vancouver Clinic also reduced bad debt through more efficient patient processing by ensuring the clinic has the right insurance and personal information on patients. By collaborating with Experian Health, Vancouver Clinic has turned things around and has already realized a reduction in claim denials and bad debts to save them $2.3 million. An additional benefit of implementing these software changes is the ability for patients to use the self-service portal for the clinic. It allows patients to get estimates for services, set up payment schedules, pay their bills, schedule appointments, and provide feedback to the health system. Giving patients the ability to take control of these tasks simplifies the process for everyone, reduces busywork for staff, and improves patient satisfaction. Another efficiency that was implemented for staff was revamping software work lists. By reducing the number of lists they had to manage, employees were able to streamline their work. In an effort to maintain and continue to improve efficiencies, several key performance indicators are monitored to ensure quality throughout every step of the process. In much the same way that manufacturing keeps an eye on each process along the way, Vancouver Clinic has sought to improve every detail to create a seamless experience for patients. Through its continued partnership with Experian Health, it is well on its way to getting there.