First Pst after migration to Cloud in Health care Blog

The Price Transparency Rule, effective January 1, 2021, requires hospitals to provide clear and accessible pricing information about their items and services online. Although the rule is simple in theory, hospitals are finding it challenging to implement. Under the rule, hospitals can make their pricing information clear and accessible by publishing it online as a comprehensive machine-readable file (MRF) with all items and services and in a display of shoppable services in a consumer-friendly format for at least 300 shoppable services. The Centers for Medicare & Medicaid Services (CMS) states that the rule aims to "help Americans know the cost of a hospital item or service before receiving it." This rule represents a giant stride towards delivering much-needed and long-awaited benefits associated with price transparency. These include empowering consumers to make informed healthcare purchasing decisions based on the costs and benefits involved, enabling cost predictability and closing the information gap between providers and patients. It is also an eye-opener for consumers, preventing them from falling victim to wide price discrepancies prevalent in an opaque pricing system. As Tricia Ibrahim-Zafari, Director of Product Management at Experian Health, states, "The requirements are meant to help patients become true consumers of healthcare." However, the success of the concept of price transparency hinges on hospitals adhering to and implementing the rule. Unfortunately, reports have found that hospitals have struggled with compliance since the rule was enacted. One of the reports, published in February 2024 by the Patient Rights Advocate, found that three years after the Hospital Price Transparency Rule took effect, only 34.5% (689) of the 2,000 U.S. hospital websites analyzed fully complied with the rule's requirements. One of the barriers to the adherence to and successful implementation of this rule is its constant and frequent evolution, making it challenging for hospitals without efficient price transparency solutions to keep up. Stricter penalties due to low compliance rates, increased public access to pricing and the challenging financial environment prohibiting flexible price changes exacerbate existing pressure on hospitals, Ibrahim-Zafari explained. The good news is that hospitals looking to meet the transparency requirements, including the Price Transparency 2024 updates while delivering high-quality care for all, can explore Experian Health and Cleverley & Associates solutions for Price Transparency compliance. These price transparency tools in healthcare help providers comply with the Price Transparency Rule, improve price defensibility and create financial opportunities, as affirmed by Ibrahim-Zafari. Price Transparency 2024 updates: the latest in the price transparency regulatory environment Jamie Cleverley, President of Cleverley & Associates, emphasized that the earlier language of the Price Transparency rule is grounded in provisions of the Affordable Care Act (ACA) and displays noteworthy similarities. Both require making consumer-relevant information easily accessible for easier comparison shopping and providing insights into negotiated rates between clinicians and insurers in a machine-readable format. However, the Price Transparency rule has evolved ever since. Since its introduction in 2021, the Price Transparency Rule has been continuously updated to better align with its intent, to adapt to the changing healthcare landscape and to encourage compliance. For example, Ibrahim-Zafari noted that in 2022, CMS increased the penalty for non-compliance with price transparency requirements from $110,000 to over $2 million a year. Additionally,  the agency imposed stricter timelines for hospitals to address pricing data issues and streamlined the enforcement process. The Price Transparency 2024 updates required to be implemented by hospitals on January 1, 2024, July 1, 2024 and January 1, 2025, fall under five broad categories: new definitions, good faith estimate and machine-readable file (MRF) attestation, ​​standardization of the MRF format and data elements, improving access to hospital MRFs and enhancing enforcement and compliance. Put simply, CMS established definitions for specific terms in regard to the new definitions category. Let's delve into the remaining categories under the price transparency 2024 updates. Good faith estimate and machine-readable file (MRF) attestation The good faith estimate and MRF update emphasize hospital leadership's obligation to verify the MRF content's comprehensiveness and accuracy. Good faith effort - Starting January 1, 2024, CMS requires every hospital to make a good faith effort to ensure that the standard charge information stored in the MRF is accurate and complete. MRF Attestation - Starting July 1, 2024, hospitals must attest to the completeness and accuracy of the applicable standard charge information in their MRF. Cleverley explains that the good faith effort update does not require hospitals to include any attestation on their website or in their machine-readable file. However, beginning July 1, hospitals will be required to use the CMS template for the MRF, which includes an attestation comment, where they must select true or false. Standardization of the MRF format and data elements CMS also introduced updates that ensure the standardization of the MRF formats and data elements across the board. Starting on July 1, 2024, hospitals must format the contents of the MRF into a specific template. This template can be in either .JSON or .CSV format. According to Cleverley, the .JSON format is digital-friendly, making it the preferred option for hospitals. The .CSV format, on the other hand, is more consumer-friendly. Furthermore, the Price Transparency 2024 updates introduced additional required data elements, including five types of standard charges. Some of the new data elements, including "Estimated Allowed Amount," "Drug Unit of Measurement," "Drug Type of Measurement," and "Modifiers," have been stated to be implemented on January 1, 2025. Improving access to hospital MRFs To make hospital MRFs more accessible, CMS requires that from January 1, 2024, hospital websites must include a .txt file in the root folder containing their MRF and contact information. In addition, hospitals are required to include a "footer" at the bottom of their homepage, linking to the webpage that hosts the MRF. Enhancing enforcement Considering that hospitals have been slow to comply with the price transparency requirements, it's not surprising that CMS is ramping up its enforcement efforts through four measures. Increasing scrutiny of hospital compliance efforts – CMS is increasing scrutiny by authorizing comprehensive compliance reviews. Under the Price Transparency 2024 updates, they can also request hospitals to have an authorized official certify the accuracy and completeness of MRF data and submit additional documentation, including payer contracts, to evaluate compliance. Acknowledging warning notices – Hospitals must confirm receiving warning notices from CMS whenever they receive such notice. Addressing system-wide non-compliance – If CMS finds a hospital part of a health system to be non-compliant, they can notify the health system's leadership to address potential defaults from other hospitals within the health system. Publicizing actions and outcomes – CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. Experian Health and Cleverley + Associates solutions for price transparency compliance Compliance with the Hospital Price Transparency Rule is indispensable to achieving price transparency. To support providers in adhering to these rules in the best and most efficient way possible, Experian Health and Cleverley & Associates solutions to provide solutions that ensure maximum compliance while improving price defensibility and creating revenue opportunities. Experian Health's Patient Payment Estimates help providers compile a consumer-friendly list of shoppable service items. Cleverley & Associates provides fully compliant and comprehensive machine-readable files for the hospital's "items and services." The price transparency tools in healthcare are available in two options to cater to the specific needs of healthcare organizations: Machine-Readable File – Standard: This solution provides machine-readable files only in the standardized payer-specific negotiated charge format. Machine-Readable File – Premium: This package provides a price transparency machine-readable file and includes consulting services to assist with price changes. Navigating price transparency requirements in the ever-changing healthcare landscape can be daunting. However, the task becomes seamless with solutions from Experian Health and Cleverley & Associates for price transparency compliance. Healthcare organizations can now stay up to date with and meet evolving transparency rules while also improving profitability. Watch the on-demand webinar, featuring experts from Experian Health and Cleverley & Associates, to learn more about the new updates and explore the latest developments and strategies to navigate price transparency in 2024.

Claim denials are costly to correct and resubmit. They impede revenue flow, slow down patient care delivery, contribute to poor patient experience and satisfaction, increase administrative workload and take up limited staff time and resources. While they're avoidable, Experian Health's State of Claims 2022 report shows that 30% of respondents say denials are increasing between 10-15% year over year, which costs health systems billions of dollars. Moreover, rebilling payers often proves fruitless. Despite taking up resources and staff time and productivity and slowing down healthcare delivery, reworked and resubmitted claims denials often face repeated rejection. A KFF brief on claims denial noted that even though it's uncommon for consumers to resubmit denied claims, insurers usually stick to their original decision when resubmissions occur. Unsurprisingly, preventing claims denial and streamlining the claims management process has become a pressing need for revenue cycle leaders. The report also revealed that 70% of respondents consider claims management and reducing denials as top priorities. However, the reality of a drop in claim denial rates becomes tangible only when healthcare organizations start to automate claims processes. Claim Scrubber sets the standard as a software solution that effectively reduces denial rates, by ensuring that providers submit clean claims from the start. What is Claim Scrubber? Claim Scrubber is an automated software solution that helps healthcare providers identify errors that may lead to incorrect billing and claims denials and submit clean, thorough and accurate claims every time. It reduces undercharges and denials, ensures timely billing and payments, improves staff time and productivity and increases cash flow and bottom lines. This tool is built to seamlessly complement Experian Health's other claims processing solutions, including ClaimSource® and Denial Workflow Manager. By adopting these solutions, healthcare organizations can enjoy the full range of benefits in their claims processing and management experience while benefiting from timely, uninterrupted cash flow and higher revenue. How does Claim Scrubber work? Claim Scrubber is designed to consistently and reliably help healthcare staff produce clean and accurate claims that are more likely to be approved by payers. Here's how: Claim Scrubber meticulously analyzes each line of every pre-claim to ensure accurate coding and information before submission to the claims clearinghouse. After completing the analysis, Claim Scrubber provides general and payer-relevant edits that pinpoint incorrect code combinations or other issues that could lead to claim denial. These edits are stored within the Claim Scrubber portal and can be conveniently accessed by users from their PMS and HIS. Claim Scrubber details reasons for flagging a claim so users can make appropriate corrections before submission. Claim Scrubber enables users to make edits in alignment with payer policies by using Experian Health's comprehensive database of commercial payer policies and content. Claim Scrubber also identifies when the billed amount is less than the payer-allowed amount, helping health systems catch and correct undercharges. Claim Scrubber cleans claims, making them error-free by working with the latest and most up-to-date data. Claim Scrubber is fully functional in batch mode. Claim Scrubber operates on a secure VPN connectivity feature to ensure secure and rapid responses for real-time integrations. How can Claim Scrubber help improve claims management? Claim Scrubber optimizes claims processing by providing revenue cycle decision-makers and their teams with solutions that identify potential coding and billing errors upfront, ensure error-free claims submission to payers or clearinghouses, prevent undercharges and underpayment, increase first-time pass rates and prevent costly, time-consuming rework and rebilling that may result in a second rejection. Additionally, Claim Scrubber enables healthcare organizations to comply with and meet price transparency rules by staying updated on coding variances. Users can also revise flagged claims, ensuring appropriate and accurate corrections are made with access to Experian Health's extensive commercial payer policies and content database. Claim scrubbing occurs within 2.7–3.0 seconds, ensuring speedy transaction processing that leads to faster reimbursements. Healthcare organizations can also enjoy these benefits without the hassle of needing servers, regular maintenance and downtime with Experian Health's cloud-based application. See how State of Franklin Healthcare Associates used Claim Scrubber to expedite accounts receivable (A/R) by 13% and reduced full-time employee (FTE) requirements even as claims volume grew. Read the case study Healthcare organizations that automate claims management gain advantages that benefit all stakeholders and bottom lines. Claim Scrubber enhances operational efficiency, staff productivity, resource utilization, patient experience and satisfaction and hospital cash flow and financial growth. Contact us today to learn how Experian Health's Claim Scrubber software can help your healthcare organization submit clean, thorough claims and get paid faster and more accurately. Learn more Contact us

According to Experian Health's State of Patient Access Survey 2024, eight in ten healthcare providers plan to invest in patient access improvements soon. As they weigh up the pros and cons of different solutions, many will focus on two key areas: making scheduling and registration easier for patients, and streamlining financial processes to boost their profitability. This blog post examines how automated patient access solutions can help providers meet patient expectations and operational demands. Survey snapshot: what do patients want? Experian Health's annual State of Patient Access surveys are useful pulse checks on patient perceptions. What do patients find challenging about accessing care? Where are they bumping up against unnecessary friction? The 2024 survey offers a promising outlook: 28% of patients report improvements in access in the last year, up from just 17% in 2023. Still, there is room for improvement: patients' biggest challenge – seeing a practitioner quickly – has topped the list for the last four years. Other significant challenges include understanding the cost of care and scheduling appointments. The State of Patient Access 2024 survey examines the perspectives from patients and providers on their perceptions of access to healthcare. Download now One key takeaway from the survey is the role of digital technology. Both patients and providers find complex, repetitive and inefficient processes to be the most problematic aspects of patient access – ideal targets for digital tools. Indeed, patients specifically express a desire for online health management tools, while more than half of providers attribute improvements in patient access to automated processes. There's a solid business case for investing in digital patient access solutions to ensure that patients see their doctors quickly and providers get paid without delay. Patient access solutions can open the digital front door with online scheduling and registration The first area where providers may consider investing in digital tools is in the patient's first interactions with their facility. When patients can schedule appointments quickly and complete registration without boring and repetitive paperwork, they're more likely to report a positive patient experience. Survey data backs this up: 89% of patients say the ability to schedule appointments any time, via online or mobile tools, is important to them 89% of patients say digital or paperless pre-registration is important to them. Online self-scheduling gives patients 24/7 access to book, cancel, and reschedule appointments from any device. Based on scheduling rules, they're shown the earliest suitable appointment, which means they'll see their doctor as soon as possible. Patients can be sent automated reminders of upcoming appointments and health checks, which means show rates and health outcomes will be better. It also drastically reduces call volumes so staff can focus on other priorities. Similarly, digital registration lets patients avoid the most dreaded part of patient intake: filling out lengthy forms in the waiting room. Automated registration also ensures that patients (specifically their data) are correctly entered into the system, preventing downstream delays. With text-to-mobile registration, patients are sent a text message prompting them to scan their identity and insurance cards, which are then uploaded and validated against existing records. Securing correct information from the start lays the groundwork for the patient's healthcare experience and the provider's revenue cycle. Interestingly, despite patient demand, self-scheduling and registration did not make the cut for providers' top three priorities. This suggests an untapped opportunity for providers that choose to invest here. Anthony Myers, Director of Patient Access at West Tennessee Healthcare, shares how their organization worked with Experian Health to accelerate and improve the registration process with Registration Accelerator. Watch now Patient access solutions can streamline insurance, eligibility and estimates A second opportunity lies in automating the patient access processes involved in revenue generation and claims submission. The revenue cycle is full of hidden costs for both patients and providers, often resulting from intake inefficiencies. Patients end up with bills that are higher than expected, while providers fall foul of changing payer requirements around prior authorizations and insurance eligibility verification, resulting in lost revenue. Improving upfront pricing estimates and clarifying insurance coverage ranked among the most urgent priorities for both groups in the survey. A few patient access solutions that can help here include: Patient estimates: When patients know in advance how much their care will cost, they can plan better. Web-based and mobile-enabled price transparency tools generate accurate estimates based on chargemaster data, claims history, patient insurance details and payer contract terms, and even account for payment plans and prompt-pay discounts. This improves the patient experience and increases collection rates while easing the burden on staff. Insurance eligibility verification: Manual processes for verifying active coverage are time-consuming and error-prone, causing staff burnout and patient confusion. Automating insurance verification checks at the time of service gives everyone greater certainty and prevents payment delays and claim denials. Personalized payment plans: By using their own data, along with third-party datasets, providers can leverage automation to offer alternative payment plans to patients who cannot pay the full amount right away. For example, PatientSimple® assesses each patient's propensity to pay and recommends the optimal financial plan that works for the patient's unique circumstances. Patients can check estimates and compare pricing plans on the self-service portal, giving them more control over their bills. These options promote financial sustainability by quickly identifying how much should be paid by which party and establishing processes to collect those amounts with minimal fuss. With ongoing staffing shortages, these time-saving tools are crucial for workforce resilience. Integrate patient access solutions with Patient Access Curator While providers may prioritize one of the above areas, the two are complementary: efficient scheduling and registration lead to better patient flow and accurate data collection, accelerating insurance and eligibility verification. This is more likely with an integrated “tech stack” across the whole patient access workflow. However, integration is a challenge for many providers. Nearly a quarter report that their biggest challenge in patient access is wrangling the multitude of tools needed to run pre-registration checks and gather the information necessary for claim submissions. Experian Health's newest patient access solution addresses this challenge by bringing together multiple insurance-related queries together into a single inquiry. With one click, Patient Access Curator automatically captures all relevant patient insurance data in less than 30 seconds. This includes: Eligibility verification, including billable secondary and tertiary coverage, chaining and primacy Coordination of Benefits, analyzing payer responses in real-time using AI to ensure no active insurance is missed Medicare Beneficiary Identifiers, using AI, automation and analytics to check and correct patient identifiers Patient demographics, using in-memory analytics and proprietary algorithms to ensure contact details are current Coverage and financial status, including automatic checks to find any existing coverage for accounts marked as self-pay or unbillable, and generate a summary of each patient's propensity to pay. With over $1 billion saved in prevented denials by clients using Patient Access Curator, it's clear that investing in digital technology is a cost-effective way to address current challenges in patient access. By increasing capacity and reducing errors and delays, these tools not only enhance financial performance, but give providers a head start when it comes to delivering an outstanding patient experience. Learn more about how Experian Health's patient access solutions accelerate access to care and streamline revenue generation from the start.