First Pst after migration to Cloud in Health care Blog

U.S. hospitals have been stuck with more than $745 billion in uncompensated care costs for the past 2 decades, and the number continues to grow.  Other factors like patients relocating, changing employers, and coverage renewals make recovering debt even harder. The recent end in COVID-19 funding has also made it more important than ever for healthcare providers to find missing insurance coverage. Finding insurance coverage can be complicated and time-consuming, especially in an already complex reimbursement landscape. However, it doesn't have to be. That's where Coverage Discovery comes in. Coverage Discovery is the only comprehensive coverage identification solution across the full revenue cycle continuum. It covers the entire patient process and uses multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms to search government and commercial payers to find previously unknown insurance coverage. This includes identifying accounts that may be submitted for immediate payment as primary, secondary or tertiary coverages. This automated coverage identification solution can search for unidentified coverage pre-service, at the point of care, and post-service. It also scans for insurance coverage continuously – to maximize reimbursements and minimize accounts sent to collections and to charity.  In 2022, Coverage Discovery tracked down previously unknown billable coverage in more than 28.1% of self-pay accounts and found more than $64.6 billion in corresponding charges. Learn more about this solution: It's time to reduce bad debt and improve cash flow. Identifying hidden insurance coverage is the first step to managing insurance denials and your organization’s healthcare financial performance. A solution like Coverage Discovery can help healthcare organizations save time, money and alleviate staffing shortages. To learn more about how Coverage Discovery can benefit your healthcare organization, contact us.

Proactive price transparency could be a competitive advantage for healthcare providers, as a Kaiser Family Foundation survey suggests a majority of Americans believe Congress should prioritize the issue. The survey revealed that 60% of respondents think legislative action to make healthcare prices more transparent should be a “top priority” for the next Congress, while a further 35% said such laws were “important, but not a top priority.” Concerns about the cost of living are top of mind for many households, with 91% of respondents specifically noting their worries about rising healthcare prices. Providers can help meet the demand for more transparent pricing by implementing solutions to make it easier for patients to understand and plan for upcoming bills. Those that proactively meet and exceed patient demand for clearer pricing information will garner more patient trust and loyalty, and in turn, secure an important competitive advantage in a challenging economic context. Why are patients calling for greater price transparency? For many patients, the process of paying for healthcare is like trying to find their way through a maze, with numerous twists and turns and no clear path forward. Unlike most other purchasing decisions, patients lack upfront information about the options in front of them. Many do not fully understand the cost of care, and as a result, may not be aware of or prepared for the forthcoming financial burden. This lack of transparency causes uncertainty and unease, leading to postponed care or missed payments. With transparent pricing, patients can make more informed decisions and choose the most cost-effective options. Those with high out-of-pocket expenses can shop around for services that best fit their budget and estimate the cost of care in advance. Transparent pricing is especially important for patients with chronic conditions or those who require ongoing care. Are providers meeting the demand for price transparency? Many providers have embraced the push for transparent pricing, by introducing upfront patient estimates and tools to help patients understand and manage their bills. Transparency may be a requirement under the Hospital Price Transparency Final Rule, but providers are also incentivized by the promise of faster payments and fewer time-consuming billing queries. However, implementation of price transparency measures has been patchy: as of August 10, 202, only 16% of hospitals were compliant with the rule. In a podcast interview for Becker’s Hospital Review with Riley Matthews, Lead Product Manager at Experian Health, Jamie Cleverley, President of Cleverley + Associates, suggests two main obstacles: confusion around what information needs to be disclosed (more on this below) concerns that sharing pricing information could negatively affect revenue. The second concern is valid, but evidence suggests that disclosing prices to patients can save money, by reducing unnecessary hospitalizations, readmissions and emergency visits. Missed payments are less likely if patients feel in control of their financial situation. In fact, research by Experian Health and PYMNTS suggests that upfront cost estimates improve patient satisfaction by 88%, which encourages prompter payments. Delivering a better patient experience with accessible pricing information To help healthcare organizations meet patient demands for clearer pricing and ensure compliance with the federal rule, Experian Health and Cleverley + Associates have teamed up to provide a standardized solution. Listen in as Jamie Cleverley, President of Cleverley + Associates, and Riley Matthews, Lead Product Manager at Experian Health, discuss how a new partnership is helping providers comply with the Price Transparency Rule: Each organization brings its specific expertise to help healthcare providers provide clear and compliant pricing information: Experian Health’s Self-Service Patient Estimates tool enables compliance with the requirement to display payer-specific rates as a consumer-friendly list of 300 shoppable items. This tool gives patients upfront, accurate estimates that are easy to understand so that they can make informed choices about their care. Cleverley + Associates helps providers make pricing information available as a machine-readable file, quickly and at scale, so providers can fulfill the requirement to display such files on their website. The solution is neatly packaged to save providers from engaging in discussions with multiple vendors or scrambling to find internal solutions for each individual requirement. Cleverley says that working with the two organizations together can save providers time and stress: “We have the information and the technical capacity to offer a format we think is useful, which complies with all the rules. There’s anxiety around this – providers worry about whether CMS will view [their solutions] as compliant. But with us, they’re working with trusted partners that have had those conversations with CMS, that have released these files already and that have been through the audit process.” For Matthews, this adds up to a user-friendly experience that’s not only compliant but gives patients what they need: “We needed to provide a patient-facing estimate-creating solution that shows those top 300 shoppable services for a hospital or a doctor’s office. We were able to do that through our existing product, Self-Service Patient Estimates. We have this portal that we can integrate with our clients’ websites, which guides patients through the entire process. What we did not have – and where Cleverley came in – were those complex machine-readable files… So, we were able to come in from both sides with price transparency and say, ‘ok, now we solve both, and we’re here to provide a holistic solution.’” From compliance to competitive advantage Penalties for non-compliance with the Price Transparency Rule may have been limited to date, but this may change as the rule reaches its second anniversary. Furthermore, some states are starting to bring in their own legislative measures to protect patients from opaque billing practices. And with patient expectations clearly stated, the pressure on providers to deliver transparency is mounting. But as noted, this is about more than compliance. Patients are looking for a clear and compassionate financial experience and will reward providers that deliver this. Providers should consider how to keep patients informed and empowered at every stage of the financial journey. Experian Health offers a suite of payment tools designed to achieve this, which bring together accurate estimates, tailored payment plan recommendations and convenient payment options. Find out more about Experian Health’s Price Transparency Solutions or watch the video to hear more about Experian Health’s price transparency partnership with Cleverley + Associates.

With inflation still high, the economic outlook remains uncertain for healthcare consumers. Many households feel squeezed by rising housing, food and fuel bills, while their incomes remain broadly static. Inflation’s impact on healthcare can be seen in delayed treatments, as a 2022 Gallup poll found that 38% of patients postponed medical care because of concerns about costs – the highest amount since the poll began in 2001. The situation is exacerbated by the fact that Medicaid continuous enrollment came to an end on March 31, 2023. To complicate things further, reimbursement rates and employer health plans tend to be negotiated in advance, which means inflation can take longer to filter through the healthcare economy. Both McKinsey and Deloitte predict that hospital profit margins will reduce in the coming year or so. Resulting price increases will be reflected in employer coverage plans, and ultimately pass to workers in the form of higher deductibles and out-of-pocket costs. In short, inflation’s impact on healthcare may continue to create ripples in the healthcare industry. For healthcare providers, reimbursement may become more challenging as patients find it harder to pay their portion of the cost. What can providers do to mitigate inflation's impact on healthcare? Providers are already working to maximize operational efficiency with automation and digital tools that reduce workforce pressures, streamline back-office processes, and leverage data to drive improvements. Reducing costs is just one side of the coin. The other is to maximize opportunities for reimbursement by supporting patients throughout their financial journey and making it as easy as possible for them to pay. Here are 4 ways that healthcare providers can mitigate inflation’s impact on healthcare while reducing friction for patients and maintaining cash flow: 1. Provide transparent pricing and upfront patient estimates Because inflation has forced patients to prioritize their spending, many are opting to postpone healthcare. But delaying treatment or stretching out medicines to save money could lead to poorer health outcomes, and potentially more expensive treatment being needed later. By proactively offering patients accurate pricing estimates before they come in for care, providers can help patients get a fuller picture of what their final bills are likely to be. Estimates can be sent directly to the patient’s mobile device, along with user-friendly links to payment plans and payment methods. This makes it much easier for patients to plan, so they’re less likely to default on payments or delay care. 2. Help patients find unknown insurance coverage With the end of continuous Medicaid enrollment, millions of patients could have gaps in coverage. While this is largely an issue for states to manage, providers can take steps to help patients find additional coverage, and support those at greatest risk to find financial assistance and plan for upcoming bills. Coverage Discovery can be used at any point in the revenue cycle to search for missing or forgotten billable coverage. It uses advanced search and proprietary data sources to check for both government and commercial insurance coverage. When coverage is found, patients get the reassurance of knowing that their bills will be covered, while providers can avoid writing off these accounts to bad debt. And because Coverage Discovery uses a contingency fee pricing model, providers only pay for the tool when they are reimbursed. 3. Offer simple and convenient methods to plan and manage bills Prescription medications, inpatient visits and other services are expected to increase in price over the coming year. Americans may be more concerned about how they’ll shoulder the costs – especially the 49% who say they’d be unable to pay an unexpected bill of $1000 or more. Providers can make the process easier for patients with data-driven digital tools. Patient Financial Clearance identifies patients that are likely to be able to pay upfront and those who may need a payment plan or financial assistance. This information allows providers to engage in compassionate financial counseling to make sure patients are guided to the most appropriate pathway. Another option is to leverage self-service tools to give patients more control over how and when they pay. Patient Financial Advisor offers pre-service estimates and payment options that patients can access anywhere, anytime. They can take stock of their financial situation, plan for bills, and then make payments at the click of a button. If it’s easier to pay, patients will be less likely to delay. 4. Make it easier for patients to schedule care While many patients may consider delaying care because of cost, many say they’ve postponed treatment for other reasons. Concerns about COVID-19, work commitments, and difficulty booking appointments can also lead to delayed care. For those that are foregoing care for reasons other than cost, providers should look at improving the patient access experience with more self-service options. Online self-scheduling allows patients to book, reschedule and cancel appointments at their own convenience. Digital patient registration similarly reduces friction, by enabling patients to fill out forms from their mobile devices. Patients will be less likely to forego care when access is as easy as ordering groceries online. Proactively reducing inflation's impact on healthcare Inflation’s impact on healthcare continues to be felt – and could get worse as the year goes on. Rising medical bills may cause patients to keep deferring care. Providers can proactively reduce the effects by incorporating digital solutions and patient engagement strategies that make it easier for patients to afford and receive care. Find out more about how Experian Health can help healthcare organizations bolster their revenue cycles and mitigate inflation’s impact on healthcare.