First Pst after migration to Cloud in Health care Blog

Recent data suggests that implementing transparent pricing has been a bumpy ride for some healthcare organizations. The federal hospital price transparency rule, which took effect in January 2021, requires hospitals to provide “clear, accessible pricing information” to make it easier for healthcare consumers to compare prices before going to the hospital. But a recent survey by Patient Rights Advocate found that fewer than 15% of hospitals are fully compliant with the requirements for machine-readable files and consumer-friendly shoppable lists. The Centers for Medicare and Medicaid Services (CMS) confirmed that around 345 warning notices and 136 corrective action plan requests were sent to non-compliant hospitals between January 2021 and March 2022. Providers that fail to improve healthcare price transparency not only risk hefty penalties, they also alienate patients who want a financial experience without surprise medical bills. It’s not an unreasonable request – how can patients take control of their health finance decisions without upfront, accurate and accessible pricing information? Proceeding with treatment without knowing the cost and then waiting months for a bill is a far from satisfying patient experience. Providers that want to satisfy both patients and policy-makers must do more to ease frictions in patient billing. Regulatory change is only part of the solution. With the right digital payment tools and strategies, providers can eliminate many of their patients’ price transparency pain points and improve their financial journey. Pain point 1: finding accurate price estimates prior to care One of the biggest pain points for patients is not having advance knowledge of the cost of care. In a survey conducted by Experian Health and PYMNTS, 15% of patients said they struggled to obtain accurate cost estimates before appointments and procedures, which curbed their satisfaction with their overall care experience. This figure rose among the most active users of digital services, with 21% of digital-first patients saying they faced challenges receiving a breakdown of estimated medical bills. Given that this group also said they would be more likely to switch providers based on the quality of digital services, getting transparent pricing right is high stakes. Providers can improve healthcare price transparency and solve this pain point by giving patients easy-access pricing information upfront. Patient Estimates can offer patients clear and easy-to-understand personalized estimates of their financial responsibility. This is done by drawing on key provider data sources and including the patient’s current insurance benefits information. Patients get estimates and payment options directly to their mobile devices, so they can choose the pathway that suits them best. This puts them in control of their payments, so they’re less likely to hit roadblocks as they move through their financial journey. Pain point 2: complex payment systems are difficult to navigate Another way to allow patients to feel in charge of their own financial journey is to offer a choice of convenient and flexible digital tools and services. A little over 20% of digital-first patients said they’d experienced difficulties when viewing invoices, setting up payment plans and making payments. As younger patients form a greater portion of new patient cohorts, there’s likely to be an increasing push for digital payment methods. Providers can engage patients before and after treatment using a text-to-mobile service such as Patient Financial Advisor, which shows patients their estimated responsibility and points them toward best-fit payment plans. This works well alongside PatientSimple, a self-service portal that puts the power in patients’ hands, allowing them to generate their own price estimates, apply for charity care and set up payment plans. Pain point 3: understanding medical bills (even with estimates) Unfortunately, many patients struggle to make sense of medical bills, even when estimates are available. Seven out of ten consumers say they would like to know the cost of care in advance, but more than half also say they’ve never thought to look for that information. A Health Affairs study found that utilization of a price transparency tool increased by 600% following marketing efforts – but patients largely chose the same clinicians as before. Even with upfront pricing information, most consumers don’t have the time or resources to assess quality and piece together fragmented bills. Providers can support patients by implementing a price transparency strategy that combines accurate pricing estimates, user-friendly interfaces and easy ways to pay with clear communications. Hospitals are turning to third-party solution providers like Experian Health to help solve their price transparency problems. Find out more about how Experian Health’s solutions can help healthcare providers improve healthcare price transparency and deliver more accurate price estimates, reduce administrative and financial pain points, and create a more satisfying patient experience.

Navigating an increasingly complex reimbursement landscape remains challenging for today’s healthcare providers, with too many claims still underpaid, delayed or outright denied. In fact, nearly 70% of providers said the problem of denied claims had worsened during 2021. Naturally, relationships with payers suffer, adding friction to the process. To this end, revenue cycle leaders are relying on claims management software to create more visibility into complex contract and claims management processes. These data tools can resolve or prevent the snags that often interfere with claims processing and billing workflows, which allow providers to streamline claims processing, improve communication with payers and accelerate a patient’s payment lifecycle. The path through that bureaucratic jungle requires high-quality information at every step. Accurate patient data, error-free clinical documentation, up-to-the-minute payer policy updates, and verified billing software and claims edits are all essential to help reduce denials and ensure faster-flowing payments.  With so many options on the market, providers should look for healthcare claims management software that provides support in four critical areas. 1. Simplified contract management Managing and understanding the tangled web of payer contracts, insurance rules and regulations can be time-consuming and overly complex. Keeping up with ever-changing reimbursement methodologies is resource-intensive for teams that are already suffering from staffing shortages. A system like Contract Manager and Contract Analysis can ease the pressure by streamlining workflows and showing revenue cycle management teams how payers are performing against agreed-upon terms. Contract Analysis seamlessly integrates with Contract Manager to provide all the data needed to make informed decisions about whether potential contract terms are in line with business goals – before any commitments are made. 2. Claims management software should help with error-free claims submissions In a perfect world, all claims would be completely accurate every time. But errors inevitably do creep in, leading to confusion, delays, and non-payments. Healthcare providers lose massive sums of money each year due to inaccurate claim submissions, denials, corrections, and rebilling. A good claims management strategy ensures that claims are error-free before they’re submitted. Claim Scrubber is an automated solution that reviews every line of each pre-claim and verifies that it is coded with the correct information before being sent to your claim’s clearinghouse. The result? Fewer undercharges and denials, optimized staff time and better cash flow. 3. Visibility of submitted claims With multiple steps, stakeholders, and milestones, keeping track of what’s happening with a claim can be cumbersome. Regardless of the workplace setting – individual hospital, large physician practice or a multi-facility Centralized Business Office – revenue cycle leaders need streamlined workflows, custom provider and payer edits, and superb customer support. ClaimSource is a solution that ensures all hospital and physician claims are clean before submission to government or commercial payers and creates custom workflows for easy prioritization and organization. With ClaimSource, providers can manage the entire claims cycle, from eligibility validation, claims editing, claims submission to the payers, claim submission reconciliation, remit retrieval, and reporting, in a single online application. 4. Claims management software should help prevent claims denials Denial rates vary widely between issuers. One 2020 study of HealthCare.gov issuers found that 1% to 57% of in-network claims were denied, while over 70% of major medical issuers had a claims denial rate of over 10%. Many reported denying one-third or more of all in-network claims. A tool such as Enhanced Claim Status makes it easy to respond early and accurately to denied, zero-pay, pending or returned-to-provider transactions before the Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) get processed. By removing the need for manual follow-up tasks and automatically submitting status updates based on each payer’s adjudication timeframe, providers can improve productivity and get paid the correct amounts faster. The claims management process is fraught with challenges. But with the right tools, data and analytics, these hurdles can be overcome. By integrating pre-claim (encounters) and post-claim (837) claims management software into the revenue cycle workflow, it's easy to review every line of every encounter. In this way, providers can verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement. Simply getting paid may not yet be as easy as providers would prefer, but technologies like Contract Manager and Contract Analysis, with their reliable customer support, can certainly oil the wheels. Find out more about how Experian Health’s Claims Management solutions with global payer edits and custom provider edits can help providers streamline the payment process and improve efficiencies, simplify the process and ensure speedy and accurate reimbursements.

Healthcare’s digital transformation promises patients ever-growing choices in how to access, experience and pay for care. Providers know that opening their digital front door is the key to attracting and retaining loyal consumers. However, deciding on the exact technologies and services to offer can be challenging. A good place to start is to follow the patients’ lead: what digital tools do they say they want? How are they using existing services (or not)? By understanding patients’ attitudes and behaviors, providers can design a digital patient journey that leads to increased patient satisfaction. A new collaborative report by Experian Health and PYMNTS provides fresh insights to inform digital patient engagement strategies. This survey, conducted in January 2022, interviewed over 2000 patients to understand how they’re using digital methods to access healthcare services and their biggest pain points. The findings revealed a need for digital services that foster convenience and choice. Digital-savvy consumers expect user-friendly online options across the care continuum, from scheduling and registration to final payment. Improving these services is also likely to encourage the less digitally confident consumers to try alternative methods and increase access to care. This article offers a snapshot of the key findings that will help providers identify gaps in their digital offerings and build a digital experience that meets consumer expectations. Finding 1: Patients are looking for digital methods to perform most healthcare activities. Patient portals are the most popular method for obtaining test results, with 44% of patients choosing this option. A quarter of patients have used digital methods to pay their medical bills. Digital methods are widely used across the patient journey, from scheduling appointments to receiving test results. Patients expect convenience, flexibility and choices, with many reporting frustrations when they can’t access the digital services they desire. Providers that offer a broad selection of digital patient engagement solutions will be best placed to respond to changing consumer demands. Beyond patient satisfaction, digital tools facilitate better care plan adherence, improve workforce efficiency, and contribute to higher patient collections rates. Finding 2: Patients are satisfied with their healthcare experience but find it challenging to confirm costs and select new providers. 15% of patients report difficulties when obtaining accurate cost estimates for appointments and procedures. Predictably, digital-first patients have the highest expectations of digital systems. They are accustomed to convenient and accessible digital processes elsewhere in the consumer world. Healthcare organizations with an open digital front door will be more attractive to these potential new patients. Digital payments could be a worthwhile investment in this regard. A previous PYMNTS survey found that 63% of patients would consider switching providers if the payment experience wasn’t up to par. To improve the payment experience, providers should consider offering upfront pricing estimates to make it easier for patients to understand and plan for their bills. A tool such as Patient Financial Advisor can act as an online financial concierge for patients, by connecting them with appropriate payment plans and contactless payment methods directly through their mobile devices. Finding 3: Two-thirds of patients use patient portals, but many find portals lack essential payment features. While 62% of patients use portals, this rises to 82% among digital-first consumers and drops to 19% among non-digital consumers. 64% of patients say cost estimates are very or extremely important, but only 24% say they receive estimates. Closing the gap between what patients expect of portals and what’s actually delivered could help narrow the differences in portal usage between different patient groups. Credit and debit cards are currently the most popular payment methods, but patients would use them less often if their preferred digital payment methods were available. Providers should consider combining high-performing patient portals with a range of payment options. Finding 4: Frictionless patient portals could prevent patients from switching providers. 61% of patients say they would switch to a healthcare provider that offers a patient portal. Improving patient portal capabilities is likely to be an important driver in attracting new patients. However, it’s also essential to retain existing patients. More than six in ten patients say they’d switch to a provider that offers a patient portal. This number rises to nearly eight in ten younger patients. A digital-first experience is no longer simply a preference, but an expectation for many consumers. To better engage and retain consumers throughout the patient journey, providers must explore the use of patient portals and other digital solutions to remove digital pain points and meet consumer expectations for a frictionless patient access experience. Download the full report to learn how healthcare providers can relieve digital pain points to offer improved patient care and satisfaction.