First Pst after migration to Cloud in Health care Blog

“As the IU Health Revenue Cycle team rallied to respond to the claims processing disruption, we were uniquely positioned with our long-time Experian partnership to quickly re-institute critical claims routines and restore a significant volume of claims transmissions.  This would not have been possible without Experian's nimble and comprehensive approach, immediately applying talented and committed resources that leveraged existing Experian platform infrastructure.” – Bryan Daniels, Vice President Revenue Cycle Solutions, IU Health Challenge Indiana University Health (IU Health) is the largest network of physicians in Indiana comprised of over 38,000 team members and 2,717 available beds. Based in Indianapolis, Indiana, the organization has dozens of facilities statewide and is on a mission to make the state one of the healthiest in the nation. In February 2024, IU Health found itself impacted by the cybersecurity incident so many providers across the country abruptly faced. They were unable to send claims to insurance companies and their revenue cycle operations came to screeching halt. Knowing they needed a trusted solution fast, the revenue cycle leadership team asked Experian Health if they could help. Solution Conversations advanced quickly and the Experian Health team was able to implement its Best in KLAS ClaimSource® platform within a week. ClaimSource is an innovative claims management solution designed for scalability and improves revenue streams by minimizing denials. By using automation, it boosts operational efficiency by prioritizing claims, payments, and denials, allowing users to tackle high-impact accounts promptly. Outcome Thanks to ClaimSource, IU Health achieved the following results: Accelerated $632 million in claims transmissions in the first five days of business. Processed $1.1B of claims backlog by March 27.  “We value our longstanding partnership with IU Health and it's very rewarding that we were able to help in a very critical situation,” said Jason Considine, Experian Health's Chief Commercial Officer. “We know IU Health places the utmost importance on patient care, and being an important part of our client's solution to deliver on their service commitment is reflective of our service commitment to simplify healthcare.” Learn more about how ClaimSource can help your healthcare organization accelerate cash flow, reduce denials and optimize efficiency.

Healthcare leaders often zero in on how uninsured rates affect their bottom line. But another patient group presents a quieter financial dilemma for providers: those with multiple active health plans. In these cases, it's important to ensure each plan pays the right amount – in the right order. Should any confusion arise, providers may end up with their claims being denied, resulting in underpayments. This is where the coordination of benefits (COB) process comes in. What is coordination of benefits (COB) and why is it important? When a patient is covered by more than one plan, the “coordination of benefits” process kicks in to help health plans figure out their respective payment responsibilities. With patients often having multiple insurance policies, ensuring that each policy pays its share is vital. The purpose of coordination of benefits is to prevent overpayment or duplication of benefits, ensuring that the total benefits paid do not exceed the actual cost of the service received. Integrating a digital COB solution within registration and scheduling workflows can help providers ensure they bill primary and secondary payers correctly, preventing unnecessary claim denials. Challenges of coordination of benefits  Coordination of Benefits is a pivotal aspect of RCM, but it's not without its hurdles. Here's a look at the complexities that often arise:  Overlapping Policies: Determining which policy pays first can be confusing. Patients with dual coverage might not always be aware of the hierarchy, leading to billing complications. And many legacy systems only select the primary, without consideration for secondary or tertiary. And regional plans add another layer of complexity.  Claim Denials: Incorrect coordination of benefits can lead to claim denials or overpayments. This not only affects revenue but also strains the patient-provider relationship when patients are billed incorrectly.  Administrative Burden: Manual COB verification is time-consuming and prone to errors. Staff often spend hours cross-referencing policies, which could be better spent on patient care.  Coordination of benefits: the dream vs. reality In an ideal world, patients would register for care weeks ahead of their scheduled treatment. During the registration process, they would inform the provider of all their active insurance coverage, with correct and complete details close to hand. No plan would go unmentioned, and no policy number misplaced. Registration staff would quickly enter the information into their EMR without error, so coverage could be verified in real-time. The reality is far different. Recent findings show that 65% of consumers struggle to understand what their health insurance covers. They do not carry copies of their insurance cards. They may not be aware that they are covered under a relative's health plan. Patient access teams are under-staffed and over-stretched, with little time to ask guiding questions that would uncover additional insurance. Coordination of benefits efforts should start as soon as it becomes apparent that a patient has active coverage under multiple plans. Unfortunately, the messy reality of coverage discovery and patient registration means patients and providers are left in the dark until a claim is denied. The payer rejects the claim for a COB-related reason, leaving billers with no clue how to resolve it. The problem gets worse from there. Automating coordination of benefits for faster, cleaner claims As with all aspects of healthcare billing, there are many complex rules and regulations governing COB transactions. Under HIPAA, health plans and payers (including Medicare and Medicaid) must coordinate benefits for each patient and determine the primary and secondary payers. Tracking this manually is extremely challenging for providers: using the information provided by the patient (which may or may not be accurate), staff would contact each payer by phone or email to verify coverage. They would then review the COB rules and guidelines for each health plan to determine the primary payer and follow specific rules for billing secondary payers. It's no wonder that COB transactions are now among the most automated administrative tasks. Automating coordination of benefits not only saves staff time, but also increases the chances of finding all active coverage, collating complete insurance profiles for the patient, and making an accurate primacy determination. Digital systems also make it easier for providers and payers to communicate with one another, facilitating smoother dispute resolution and regulatory compliance. Patient Access Curator brings real-time COB to EH clients In late 2023, Experian Health acquired Wave HDC, bringing clients a new and unrivalled package of real-time coverage and benefits solutions based on AI-powered data curation. This new solution, Patient Access Curator, helps healthcare billing teams prevent claim denials in seconds through real-time data analysis. This includes COB curation, which automatically analyzes payer responses to identify hidden cues that staff cannot see. If other insurance is identified, the tool alerts the user and triggers additional queries to verify active coverage and build a complete insurance profile for the patient. Each policy is then analyzed further to determine the patient's primary, secondary and tertiary coverage, reliably sifting out any non-billable coverage. Since 2020, the technology powering Patient Access Curator has prevented denials amounting to more than $1 billion. Integrating coordination of benefits automation yields savings throughout the revenue cycle Integrating COB automation with other RCM tools, such as coverage discovery and eligibility verification, means providers can prevent and manage denials in a single workflow. Doing this during patient registration allows teams to resolve issues in the early stages of the revenue cycle, rather than wait to deal with them once claims are denied. While catching errors on the front-end results in faster patient registration and clean claims first time, the tool adds value later in the revenue cycle, too. Streamlining the correction process prevents revenue loss and reduces the need for manual intervention. Here's how these use cases look in practice: In one multistate practice, the technology automated COB curation with insurance verification during patient registration. This enabled primary coverage corrections for 12% of patient registrations and identified undocumented Medicare and Medicaid coverages for 6% of registrations. Left unchecked, these omissions would have resulted in denials, delays, and missed revenue opportunities. The technology was deployed in the denials workflow at a large health system, where it identified COB corrections for 92% of all COB denials. Of these, 60% were immediately refiled to the correct primary payer, minimizing delays in revenue recovery. In the remaining claims, the tool found evidence of inaccurate or outdated third-party liability records within payer claim adjudication systems. Providers urgently need revenue cycle processes to be as efficient and reliable as possible – especially when dealing with patients with multiple, complex health plans. A powerful denial prevention solution that slots neatly into the registration workflow means they can maximize revenue with minimal human intervention. And with accurate results delivered in seconds, Patient Access Curator could be just what the doctor ordered. Get in touch today to find out more about coordination of benefits automation and discuss other ways to increase efficiency on the front-end of the revenue cycle, using Patient Access Curator.

Discovering that a patient's insurance doesn't cover planned care is frustrating for patients and providers. With revenue and patient satisfaction on the line, verifying active coverage should be simple and efficient. However, the process often involves digging through an ever-expanding mountain of data, which consumes valuable time and resources. Increasing patient volumes, frequent payer updates, and new demands for pre-authorization all play a role. Additionally, the impact of nearly 12 million Americans losing Medicaid coverage since April 2023 adds to the challenge.  It's unsurprising that many healthcare organizations no longer rely on manual processes to verify a patient's insurance details. To address these issues, many providers are turning to medical insurance verification software. The CAQH 2022 Index reports that automation of eligibility and benefits verification has increased by 25% over the last 10 years, as providers turn to medical insurance eligibility verification software for more reliable results. This article looks at how these tools are helping healthcare organizations increase their profitability and the questions to consider when selecting the right eligibility verification solution. What is medical insurance verification software? Medical insurance verification software automates the process of checking that a patient's insurance information is current and correct. With just a few clicks (or just a single click when using Patient Access Curator), the software collects data from multiple sources to confirm that prescribed services or treatment are covered by the patient's health plan. Unlike manual processes that involve checking individual payer websites and cross-referencing patient data by hand, an automated solution returns accurate information in an instant. Adoption of this software has grown significantly in recent years because of its ability to drive operational efficiency and reduce revenue loss. More than 90% of medical providers now opt for electronic eligibility verification, according to the CAQH 2022 Index. The report highlights this as a top savings opportunity for the industry, having helped providers avoid almost $81m in costs arising from manual transactions. It's particularly cost-effective for smaller organizations with tighter budgets. How it works: the eligibility workflow Here's what the insurance eligibility verification process looks like in practice: As soon as the user registers the patient, they can make an eligibility request and the software immediately determines whether the patient has coverage on file and whether that coverage has been verified. An optional MBI lookup service can be used to check transactions against MBI databases to see if the patient may be eligible for Medicare. If a patient is eligible for Medicare, the response will confirm the type of Medicare and flag up any missing patient information. If they are not eligible, the transaction will be routed through the regular verification process. For non-Medicare transactions, the software will confirm any other coverage found and provide subscriber details. Benefits of medical insurance eligibility verification software for providers and patients As with all data-driven revenue cycle processes, even the smallest eligibility verification errors can result in denied claims, wasted staff time and lost dollars. Automating the process minimizes the risk of incomplete patient data, outdated insurance information and simple human mistakes. But while accuracy is paramount, the benefits of insurance eligibility software go much further: Boost cash flow and cost savings: Identifying the correct insurance coverage improves the billing process to increase and accelerate reimbursement. With fewer denied claims, more revenue comes in the door and staff time need not be spent on costly rework. Increase operational efficiency: Software automates and streamlines the verification process, saving time and reducing the burden on staff. As labor shortages persist, fewer staff may be available, so any action that makes better use of resources will result in efficiency gains and let staff focus on higher-value tasks. Simplify workflows: Busy providers don't have time for lengthy onboarding exercises or training programs. An eligibility verification product with an intuitive interface that integrates with other information management systems can shortcut the learning curve, while alerts and smart work queues help staff prioritize the right tasks. Leave room to grow: Providers need solutions that can scale in step with increasing patient numbers and administrative complexity. Medical insurance eligibility verification software can adapt to changing needs with minimal disruption. Improve the patient experience: A more reliable verification process means providers can generate accurate and timely cost estimates for patients, which makes it easier for them to understand their financial responsibility and plan for bills. And by eliminating time-consuming manual tasks, software speeds up registration and gives staff more time to focus on patient care. Again, this means more dollars coming in the door. Key features to look for in medical insurance verification software When selecting a platform, healthcare organizations should consider the following questions: Does it pull from reliable data sources? Does the software integrate with existing payer and information management systems? Is the system easy for staff to use? Does it incorporate monitoring and reporting functions? Does the supplier offer ongoing support? Experian Health's Insurance Eligibility Verification solution was developed with these questions in mind. It gathers data from more than 900 payer websites, along with other sources, to generate detailed responses. Advanced search optimization increases the chance of a positive match, so no active coverage slips through the net, while the CAQH COB Smart® Data feature enhances coordination of benefits information for accurate, real-time responses. Providers that already use Experian Health products, such as eCare NEXT®, can access Eligibility through the same interface, so staff can use it right away and generate combined performance reports. One of the major advantages of Eligibility is the optional Medicare beneficiary identifier (MBI) look-up service, as described below. And now, healthcare providers have an additional tool to add to their eligibility arsenal: Patient Access Curator. With Experian Health's recent acquisition of Wave HDC, users can leverage AI-guided data capture technology to quickly check and correct patient insurance information. Patient Access Curator not only verifies insurance eligibility, it also facilitates accelerated coordination of benefits processing, runs automated MBI checks, searches for missing coverage, and analyzes a patient's propensity to pay – all in a single click. Close the coverage gap with medical insurance verification software While insurance verification software improves eligibility review processes, one question remains: how can providers help patients who are found to have invalid coverage? One option is to help patients find alternative coverage, using a solution like Coverage Discovery. Similarly, Patient Financial Clearance can identify patients who may be eligible for Medicaid or charity assistance, and can point them toward manageable payment plans if they have a self-pay balance. In this way, automated solutions can go even further to help providers create a positive patient experience and ultimately reduce the burden of bad debt. As providers embrace the benefits of automation, selecting the right solution is crucial. Tools that integrate workflows throughout patient access and the wider revenue cycle will make it easier to manage change, maximize resources and boost profitability. Find out more about how Insurance Eligibility Verification helps healthcare organizations increase reimbursements with automated eligibility checks.