First Pst after migration to Cloud in Health care Blog

In 2014, Sanford Health set out to improve its success rate in collecting past-due patient bills. The health system increased its in-house collections by more than $40 million, and in a single year, it sent 28.5 percent fewer collections to outside agencies. How did Sanford Health do it? The patient account team improved its collections process with a hybrid approach of new tools and new ideas for patients and employees alike. Create a transparent system to identify the highest-yielding accounts Collections Optimization Manager allows the team to better manage patient collections by finding the patients who can and will pay. This is a big win. The team avoids wasting time and other resources on low-yield accounts. More importantly, when patients need Sanford Health’s financial assistance and charity services, they get the compassionate care they deserve. Previously, Sanford Health manually tracked and called patients who were late paying their bills. It was a cumbersome collections process, and the team had no way to focus its efforts on those people with the propensity to pay. The Collections Optimization Manager’s analytical models use precise algorithms to create segmented groups according to those patients who would prefer to pay in full at a discount, those who would prefer to pay on an installment plan, and those who are likely to be eligible for financial or charity assistance. Seamlessly integrate the new tool with existing ones The team coupled the new optimization manager with PatientDial, which they were already using and which routes calls to patient account representatives based on segmentation and decreases the cost of the collections process. Integrating with other products made it possible for Sanford Health to build upon previous success and easily implement the optimization manager with limited intervention from its IT department. Sanford Health was already using two other Experian Health products as well. First, Claim Scrubber helps Sanford Health submit clean claims to insurance companies and other payers, thus reducing undercharges and denials, optimizing staff time, and improving cash flow. Contract Manager and Contract Analysis audit payer compliance so the patient accounts team is assured that collections align with contract terms. Couple new tools with fresh, simple ideas Patient Statements is the final tool Sanford Health had already implemented when it embarked on its journey to improve the patient collections process. But it went a step further by redesigning the cover page. Now, patients can easily understand their payment options, including prompt-pay discounts. Also, the health system instituted an employee incentive program, which rewards staff members for their collections performance. Sanford Health is the largest nonprofit rural healthcare system in the nation. It has 45 hospitals and 289 clinics in nine states and four countries. It employs more than 28,000 people, including more than 1,300 physicians in more than 80 specialties. As Sanford Health grew and acquired new services, it realized that it couldn’t rely on a purely manual process to handle its collections process. Collections Optimization Manager turned out to be a profitable and otherwise satisfying collections solution. Collecting past-due bills is about money. And any business — even one focused on health and healing like Sanford Health is — must turn some of its attention to making money. But collections can be about more than that. It can be about making patients happier. It can be about figuring out who needs your help and exactly what kind of help they need. That’s what Sanford Health focused on, and it paid off. Learn more about how Sanford Health improved its process and collections success rate. Read the case study.

Yale New Haven Health is an award-winning academic healthcare system, and a big part of why its people achieve success is because they continually ask, “How can we do better?” For two years, the financial preservice team used focus groups and other feedback to learn about the financial concerns of patients and their loved ones. Then, they pursued a rigorous, tech-driven transformation to better develop estimates, identify patient payment solutions, explain billing and collections, and engage with patients. Yale New Haven Health employees and executives view patients’ financial care as an important facet of healthcare. By pairing their own dedication and know-how with Experian Health products, they’ve improved the patient experience and increased staff satisfaction. Here’s how: Create transparent, plain-language patient estimates The preservice team wanted to give patients cost estimates that were easier to understand and more accurate. Now that they’re using Eligibility, team members know exactly what procedure a patient is having and are better equipped to verify eligibility and explain the patient’s deductibles, co-insurance, and out-of-pocket expenses. For example, the team has standardized the varying (and sometimes cryptic) eligibility responses returned by hundreds of different insurance companies and other payers. Team members give patients the same clear answer — no matter how many ways payers use to describe what their plans will and won’t pay for. Find alternative payment solutions Another challenge confronting Yale New Haven Health was helping patients find ways to pay for procedures. The preservice team deployed Coverage Discovery, which can find and verify insurance coverage that patients didn’t even know they had. As patients register for their procedures, the tool searches for previously overlooked Medicare, Medicaid, and commercial insurances. Patients can sometimes avoid costly self-pay situations, and Yale New Haven Health avoids write-offs and unwarranted charity designations. Also, the preservice team is watching trends in what Coverage Discovery finds so they can spot potential problems earlier and identify payment alternatives sooner. Make it less painful to receive a bill It’s nearly impossible to achieve pain-free billing, but the confusing terms and codes found on most healthcare statements shouldn’t add to the pain. As part of its financial care transformation, Yale New Haven Health started using Patient Statements to combine hospital and physician billing into one easy-to-understand document. It even added customized messages to further explain the procedures and costs. Patients have said that they’re happy with the new design. Give patients a way to be self-sufficient Patients want an easy, digital way to evaluate options and understand what products and services cost. Healthcare is no exception. Yale New Haven Health uses Patient Self-Service to serve up a self-service portal that gives patients a greater say in their healthcare and connects them to their providers. For example, patients can set up their own payment plans (within parameters set by Yale New Haven Health). It saves time for the patients and the preservice team, which enjoys a reduced volume of customer service calls. Yale New Haven Health already had a relationship with Experian Health. It was already using Payer Alerts and Collections Optimization Manager to improve back-end revenue cycle operations. This time around, it focused on preservice processes and added Eligibility, Coverage Discovery, Patient Statements, and Patient Self-Service to its financial care system. These tools have garnered more satisfied patients, to be sure. They’ve also served as physical expressions of Yale New Haven Health’s commitment to excellence. Staff members can take greater pride in their jobs knowing they have the tools to better fulfill their patient-centered mission. A lot is said about treating the whole person instead of just the disease. By approaching financial care as an important companion to clinical care, Yale New Haven Health has discovered countless ways to answer the question “How can we do better?” Learn more about Yale New Haven Health’s patient financial care transformation. Read the case study.

As deductibles and premiums increase, more patients struggle to pay healthcare bills, and, in turn, the patient collections process becomes more and more daunting. Hospitals and clinics are now relying on debt collection agencies more than ever. At Experian Health, we estimate a 119 percent increase in this specific outsourcing over a four-year period, from 2014 to 2018. A third-party debt collection agency is attractive for many reasons. For one, it frees up your healthcare practice’s valuable resources. Also, patients with delinquent bills typically respond well to a debt collector’s call. However, using a debt collection agency does not relieve all concerns because you must consider vicarious liability. By law, your hospital or clinic can be held responsible for the debt collection agency’s actions when it acts on your behalf. To keep your healthcare practice out of legal trouble and clear of costly fines, ensure the debt collection agencies that you hire comply with relevant laws and regulations. Also, consider using tools to make sense of these complex requirements. Do You Know the Laws Controlling Debt Collection? The legal requirements governing debt collection are varied and frequently evolving. It can take a lot of work to keep up with them, but there’s a tool to help you. We’ll describe this tool in just a moment, but first, let’s review a sample of federal debt collection laws and regulations to make sure you’re up-to-date: The Fair Debt Collection Practices Act (FDCPA) limits the behavior and actions of collectors who attempt to collect debts on behalf of another person or entity. This federal law aims to eliminate “abusive, deceptive, and unfair debt collection practices.” The Telephone Consumer Protection Act (TCPA) governs interactions between businesses and their customers, including healthcare providers and their patients. In many cases, this federal law requires consent before a provider can communicate with a patient’s mobile device through automated dialing systems, such as auto-texting or “robocall” systems. The Fair Credit Reporting Act (FCRA) regulates the collection, dissemination, and use of consumer information, including credit information. The Gramm-Leach-Bliley Act (GLBA) requires institutions to explain their information-sharing practices to customers and any available opt-out provisions. IRS Code 501(r) is a federal regulation enacted by the Affordable Care Act. It mandates certain financial assistance practices in order for an organization to maintain a nonprofit 501(c)(3) status. A key provision holds many hospitals and healthcare systems accountable for the acts of their debt collection agencies. The Electronic Fund Transfer Act (EFTA) establishes the rights and liabilities of consumers in electronic fund transfer activities, as well as the responsibilities of all parties. The Truth in Lending Act (TILA) requires disclosures about lending terms and the costs associated with borrowing.