First Pst after migration to Cloud in Health care Blog

The Health Resources and Services Administration (HRSA) recently ended its COVID-19 Uninsured Program (UIP), meaning that providers can no longer seek reimbursement for COVID-19 testing, treatment and vaccine administration for uninsured patients. Evidence suggests that there could be new infections in the fall and winter, which means the need for testing and treatment has amplified. A $10 billion COVID-19 funding proposal that followed this program is also being held up in Congress, which means that it can take much longer before funding is provided. While this bill may eventually be approved, it is unlikely to include uninsured Americans. This means healthcare organizations must be extra vigilant to find missing insurance coverage for COVID-19 care. The challenge is broader than the end of the UIP program. Continuous Medicaid enrollment will also come to an end when the pandemic is no longer considered a public health emergency. Providers will need to resume eligibility and renewal checks, which will cause massive disruption as millions of individuals potentially lose coverage. In the face of reduced reimbursements, providers may have no choice but to turn away uninsured patients or absorb care costs themselves. But there is a third option – to check for missing and undisclosed coverage and maximize opportunities for reimbursement throughout the patient journey. This can be resource-intensive if not implemented strategically. It often requires a major investment of staff time and effort, which many organizations can hardly afford, as a result of staffing shortages and larger financial pressures. However, with the right data, automation and coverage discovery strategies, providers can maximize available reimbursements and minimize disruption, without eating up staff resources. Here are 4 strategies to find missing insurance coverage and increase reimbursement as COVID-19 funding ends: 1. Run continuous checks for missing coverage As churn increases gaps in coverage, providers must perform due diligence to find coverage for their patients. Many patients have forgotten or undisclosed coverage; however, tracking it down can be an administrative nightmare. It requires staff to run multiple checks of public programs and disparate payer networks, with no guarantee that coverage will be found. With such huge changes to the Medicaid landscape on the horizon, manual checks are not an option. Providers must find an efficient way to check coverage for patients who need COVID-19 testing and treatment, or for those who may be losing government coverage. Experian Health's Coverage Discovery uses advanced data analytics and automation to help providers locate hard-to-find coverage, without placing an undue burden on staff who are already under immense pressure. Coverage Discovery uses millions of data points and sophisticated confidence scoring to comb through government and commercial payer databases, eliminate write-offs and speed up reimbursement. It automatically runs checks before the patient comes in for care, at the point of care, and post-service. This ensures that if the patient's coverage status changes during their healthcare journey, potential reimbursement opportunities won't slip through the cracks. This solution helped identify previously unknown billable insurance coverage in more than 27.5% of self-pay accounts in 2021. 2. Verify coverage as early as possible Federal funding during the pandemic required states to expand Medicaid support, leading to an unprecedented 85 million enrollees. As emergency support winds down, state Medicaid agencies will have one year to check the eligibility of each individual and notify those who no longer qualify. With each check taking around two to three months to complete, agencies and providers will need robust workflows to maximize capacity and communicate with patients. A KFF survey in March 2022 found that only 27 out of 50 states had plans in place to address eligibility redeterminations and disenrollments once continuous enrollment ends. Access to reliable datasets and automated software can help providers confirm patient contact details and continue checking for coverage as patients transition from one plan to another. Should coverage be found, providers then need to verify that planned treatment or services are eligible for reimbursement and determine the patient’s financial responsibility. The sooner this can be done, the more likely it is that bills will be settled. Experian Health's Insurance Eligibility Verification solution can be part of the strategy to streamline eligibility checks and verify active coverage earlier in the billing process. This continuous, automated workflow uses real-time data to drive higher reimbursement rates so that providers can focus on providing the best care for their patients. 3. Get patients onto the right plan to increase rapid reimbursement In many cases, government and commercial coverage only cover a portion of a patient's medical bill. If more patients are responsible for a greater portion of costs – whether for COVID-19-related care or otherwise – there's a higher risk of delayed payments. Confusion over federal funding or changing Medicaid coverage could compound this. Providers can improve recovery rates by assessing a patient's ability to pay early in the process, and quickly steer them toward the right financial pathway. Patient Financial Clearance determines which patients are more likely to pay and connects others to payment plans and financial assistance programs, so collections teams know where to direct their resources. Not only does this improve workforce efficiency and avoid missed reimbursement opportunities, but it also means that fewer patients will have to miss out on necessary care because of ambiguity over how it will be funded. 4. Optimize collections to direct resources to the right accounts Another way for providers to protect their revenue once federal reimbursements end is to optimize the collections process. Collections Optimization Manager helps providers adopt a targeted collections strategy, to focus on accounts with the highest likelihood of being paid. Novant Health used Collections Optimization Manager to automate patient collections for a faster, more efficient and more compassionate collections experience. This collections technology allowed the team to tighten up patient segmentation, allocate staff resources more efficiently and keep a closer eye on agency performance, leading to a 6.5% recovery rate and a 5.8% increase in unit yield year-over-year. Learn more about how Experian Health's Coverage Discovery solution can help providers find missing insurance coverage and secure higher reimbursement rates as pandemic support programs come to an end.

Earlier this year, Experian Health teamed up with PYMNTS to ask more than 2300 consumers about their digital healthcare habits. The results confirmed that consumers are eager to use digital channels, but still experience challenges in finding options that meet their expectations. The Digital Healthcare Gap: Streamlining the Patient Journey examines how healthcare providers currently use digital tools to allow patients to book appointments, obtain test results and make payments. It also examines how providers are closing gaps. This article summarizes the key insights that will help providers create a seamless digital experience and improve patient engagement. Download the report to get the full study, and to learn how healthcare providers are using digital channels to improve care and drive engagement. How are healthcare providers using digital channels to streamline access to care? While most patients still prefer to interact with healthcare providers in person or by phone, digital methods are increasingly popular. For example, Experian and PYMNTS data show that: 1 in 5 patients used digital channels to schedule appointments within the previous year. 1 in 3 patients used patient portals to fill out registration forms. 1 in 4 patients used digital methods to pay for healthcare. Urgent care patients were the most likely to schedule appointments online, with 17% using patient portals, 16% scheduling directly through practice websites and 5% booking by text message. Patient portals were also the most popular digital channel among patients booking appointments with family practices. These insights suggest that patients want on-demand patient access and a range of options to book, register and pay for care in a way that’s most convenient for them. When they have that choice, many opt for digital methods, though results vary by type of provider. Patient portals are emerging as the most popular channel because they allow patients to securely access and manage their healthcare information in one place, whenever and wherever they like. Missed us at the MUSE Inspire Conference? Contact us for more conversations about opening healthcare’s digital front door. How can providers better engage patients using digital healthcare solutions? Despite their enthusiasm, many patients run into challenges when using patient portals, especially when making payments. Obtaining accurate cost estimates before coming in for care was a major pain point for 15% of patients surveyed. Portals are an obvious solution, but only 24% of patients said they had access to portals that include this feature. Even among those patients with access to “estimate-enabled” portals, only 6% said they knew their out-of-pocket costs in advance, which may point to communication or usability issues. The ability to receive cost estimates in advance of treatment has a major impact on how satisfied patients feel with their overall care experience. Nearly 85% of patients said they were satisfied with their care, but those who did not receive cost estimates for their most recent appointments tended to be less satisfied. The portion of urgent care patients satisfied with their experience dropped to 74% when out-of-pocket expenses weren’t known in advance. Experian Health’s Patient Estimates can help address these gaps. This web-based pricing tool gives patients accurate cost estimates before their treatment and offers advice for financial assistance and charity options. Patient Financial Advisor complements this by delivering pre-service estimates of the patient’s responsibility straight to their mobile devices. With this solution, patients get a text message with a secure link to their cost estimates and payment options. Providers that offer a convenient and transparent financial experience through these types of digital tools are likely to see improved patient engagement and more efficient patient collections. Tom Cox, President of Experian Health, says that digitally-enabled convenience is the secret to better patient engagement. “Patients are consumers before they are patients. They may not be experts in medicine, but when it comes to convenient and efficient scheduling, registration, estimates, payments, communication, and flexible delivery of these services, the consumer becomes the de facto expert. Healthcare is quickly approaching the point where a standard of convenience and ease of use – primarily delivered via digital tools ­– will result in patient attrition for those failing to meet the standard. The ’innovation’ needed is to reach parity with the experiences consumers have in their other service interactions.” “Healthcare is quickly approaching the point where a standard of convenience and ease of use – primarily delivered via digital tools ­– will result in patient attrition for those failing to meet the standard.” – Tom Cox, President at Experian Health How can digital healthcare solutions attract and retain new patients? The research also found that opening the digital front door can supercharge efforts to attract new patients. 3 in 10 patients use digital methods to find and select providers, with 1 in 10 using online reviews as part of their search. Nearly 2 in 10 struggle to find the professionals they need. Building a consistent online presence can help increase providers’ “discoverability” and signal a commitment to digital healthcare that so many patients desire. Providers that offer easy and reliable digital tools are also going to be more likely to attract and retain new patients. With 20% of patients saying portals are complicated to use, and 13% saying they lack functionality, providers that offer streamlined digital services are going to be more attractive. Building on the existing momentum with online self-scheduling and self-service patient registration can make it easier for patients to choose and register with new providers. Cox recognizes that digital solutions are not a simple fix – but worth the effort. “As consumers, we take something like scheduling for granted. What goes on behind the scenes is pretty complicated, however. In the case of scheduling a medical visit, there are specific time slots, physician schedules, how to address cancellations and the need for referrals, among many other variables…. It can be challenging for a healthcare provider to aggregate disparate data into a digital tool that’s easy for patients to engage with. That’s why solution partners like Experian Health are critical to help deliver a better patient experience.” Find out more about how Experian Health’s tried and tested digital tools can help providers streamline the patient journey.  

When it comes to patient access, friction can lead to bad patient experiences. If patients can’t see a quick way to schedule a medical appointment when they visit their provider’s website, they’ll click away. If registration involves sitting in a waiting room with piles of paperwork, they’ll be reluctant to attend. If patients are confused by complex billing processes, they’ll put it off until they have the time and energy to engage. A recent survey by PYMNTS and Experian Health found that 61% of patients would consider switching to a provider that eliminates these pain points in patient access and offers more streamlined patient access, for example, through a patient portal. Beyond consumer satisfaction, convenient and flexible patient access makes financial sense for providers. It can help reduce no-shows, enable better use of staff time and accelerate patient collections. It also paves the way for higher quality care. After all, if patients are deterred from attending appointments and/or thinking about switching providers, it’ll take much longer for them to receive their diagnosis and treatment. What does “convenient and flexible” mean in practice? It means deploying digital patient access software that allows patients to complete intake tasks at a time and place that suits them. Self-service scheduling, automated registration, and personalized outreach around billing all help to create a friction-free consumer experience – and a more consistent cash flow. Rethinking patient access with patient-friendly digital solutions Consumer feedback in the survey by PYMNTS and Experian Health suggests there’s an opportunity to rethink patient access to meet patients’ digital expectations. Here are some examples of revenue-boosting swaps that will help create a patient access and intake experience that keeps patients coming in: 1. Instead of time-consuming queues and call center bookings → offer convenient online self-scheduling Around a fifth of patients say they’ve used digital scheduling tools, including patient portals, websites or text messages. Patients want to be able to schedule appointments when it suits them, rather than having to call within fixed hours to speak to a call center agent. Online self-scheduling allows patients to quickly find and book available appointments. Some providers may worry that these systems can’t account for their complex scheduling rules, but that’s not the case. Built-in guided search functions can factor in the provider’s scheduling rules, so patients are only offered appointments with the right providers. It’s easier for patients, and it’s far more efficient for staff. Relying on institutional knowledge and thumbing through giant binders of questionnaires can be stressful, time-consuming and error-prone. Online patient scheduling platforms eliminate these challenges. 2. Instead of patchy patient data → get accurate and complete patient identities One of the biggest challenges in patient access is capturing and utilizing accurate patient information. Typos, missing demographic details, out-of-date contact information and duplicate data all contribute to gaps and errors in patient identities. Without complete and reliable patient records, providers run the risk of delivering substandard care and suffer from preventable revenue loss. Instead of relying on manual data input processes, providers need digital systems that ensure the information added to a patient’s record is correct and complete. Experian Health’s Patient Identity Management solution pulls from the industry’s most reliable data sources to verify each patient’s information. It arms staff with automatic updates and alerts them to any potential discrepancies. Identity Verification helps improve the patient experience, minimize payment delays, and protect patients and healthcare organizations from identity theft. With more accurate data, collections are more efficient, leading to faster revenue recovery and fewer costly denials. 3. Instead of losing revenue to unnecessary write-offs → run automated coverage checks to find forgotten insurance If patients are unsure of their insurance coverage status, providers must invest time and resources to check for missing coverage. This pain point is currently in sharp focus, with the end of the COVID-19 Uninsured Program and the end of continuous Medicaid enrollment. As patients’ coverage status changes, providers must be able to run efficient checks for any potential missing or undisclosed coverage. Experian Health’s Coverage Discovery tool can run automated checks to look for billable coverage, as soon as the patient first interacts with the organization. Data-driven coverage discovery gives patients clarity about what they owe so they can plan ahead and allows more efficient use of staff time. 4. Instead of opaque pricing information → make it easy for patients to understand and pay bills Patients want transparent healthcare pricing. However, 15% of patients said they found it difficult to get accurate price estimates before coming in for care. The complaint was more frequent among the most digitally active patients – who are also more likely to switch providers based on the quality of digital services. Despite a recent push toward price transparency, there’s still a long way to go, with many providers struggling to comply with new federal price transparency requirements. Upfront pricing estimates make it easier for patients to understand and plan for their medical bills. With Patient Payment Estimates, patients get a clear, personalized breakdown of their expected financial responsibility sent directly to their mobile device. Patient Financial Advisor takes this a step further, by offering a text-to-mobile financial experience that connects patients with estimates, payment plans and contactless payment methods. Providers that offer convenient and flexible ways to pay will be best placed to protect profits. Discover how Experian Health’s digital patient access software solutions can help attract and retain satisfied consumers and bolster the bottom line.