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There’s no doubt that identity theft is a concern for any industry that handles sensitive customer information; health care is no exception. In 2017 alone, the U.S. Department of Health and Human Services reported 477 healthcare breaches. Together, they compromised nearly 5.6 million patient records. Without adequate IT security, everything that organizations use to improve patient engagement and the continuum of care – especially patient portals – becomes an open door for hackers. But how do we keep patient data secure without burdening patients? We asked Victoria Dames, Experian’s senior director of identity management, how the healthcare industry is evolving to solve for identity theft, as well as best practices all healthcare organizations can adopt to better meet this growing threat. In the world of healthcare, both patients and providers are understandably hyper-sensitive about the exchange and security of healthcare data. How is the industry arming itself to protect data? Are there any shifts you’ve witnessed in security practices over the past few years? Absolutely! The industry has quickly evolved into leveraging technology to share data between organizations and with their patients, but this does bring inherit risk. Criminals also took notice to this shift, and medical identity theft became one of the fastest growing types of identity theft with a roughly 22 percent annual growth. With this evolution, the industry has tightened up on data access, especially as it pertains to the patient. Over the last five years, we’ve seen the shift to enable technology to help identity-proof patients before granting them access to sensitive information. This used to be a manual process. What are some of the best practices healthcare organizations can adopt to limit instances of medical identity theft? First, organizations must understand where their access points are throughout their ecosystems. With 64 percent of patients citing a privacy issue as a key concern for accessing health information online, they should inform patients that they’re providing secure methods for access to their information. Additionally, healthcare organizations must evaluate how physicians access different types of data and portals. As healthcare caught up to electronic records and systems, portals for e-prescribing also arrived. Given the nature of this use case, providing a heightened NIST level of identity proofing is required. The key is to assess what level of identity proofing is needed at each entry point to keep balance on security and the end-user experience. When you look to the future of healthcare, what types of digital technologies and solutions do you see providers putting in place to prevent fraud and protect patient data? Technology moves quickly and so do we. Identity proofing has seen an acceleration in the use of biometrics at different points of entry throughout healthcare organizations, which strengthens our solution. We are starting to see the use of biometrics, similar to your phone face ID, used more broadly through healthcare in conjunction with existing identity-proofing solutions. Experian achieved the Kantara Initiative certification with adherence to the latest guidelines achieving NIST 800-63-3 IAL2 (National Institute of Standards and Technology Special Publication Digital Identity Guidelines 800-63-3 for Identity Assurance Level 2 (IAL2)). This reinforces our commitment to support clients in authenticating consumers, while balancing a positive experience. Learn more about Experian’s identity management solutions.

It's no secret that claim denials cost healthcare organizations. They take about 16 more days to pay out than claims that have not been denied. On average, this delay in payment equates to one percent of a healthcare organization’s cost structure.   Final claim denials — or claims in which the payer never pays the provider — lowers a typical hospital’s annual net revenue by 1.9 percent. These tack on additional administrative costs because of the work it takes to close them.   The good news is that 76 percent of claim denials are eventually paid off — but the staff time it takes to get the payments can be costly.   Claims roadblocks   Experian Health recently worked with a large healthcare organization that manages more than 200,000 claims per month, which exceeds $1 billion in claims dollars. The organization has almost 50 hospitals in its network, as well as urgent care and cancer care centers, which creates a large number of transactions and claims to process. This includes Medicare, Medicaid, private insurance, worker's compensation, managed care, and more.   Before partnering with Experian Health, a number of errors were leading to denied claims, including discharge-not-final-billed errors, claims errors, stop bills, late charges, clearinghouse edits, and other factors that created roadblocks. But claims automation helped turn things around.   Automation reduces errors   Automation provides benefits to healthcare organizations and patients because it speeds up evaluation, ensures correct and timely billing, and reduces the number of manual touches needed for each claim.   According to the Council for Affordable Quality Healthcare, manual processes slow down claim reimbursement. People take an average of four minutes to process claims, but automation reduces this to three minutes.   Although a minute doesn't sound like much, it translates to thousands of hours saved for a healthcare organization that processes 200,000 claims each month. Automation also frees up time for billing teams to focus on more pressing tasks.   How organizations can benefit   By automating, this healthcare organization could ensure clean claims by utilizing an expansive library of national payer edits and implementing custom edits. This eased the follow-up process because teams had detailed insight into claims status, an analysis of denial reasons to efficiently process them, and automated workflow and payment posting to handle splits and contractual adjustments.   One of the biggest reasons this healthcare organization partnered with Experian Health was the ease of implementation with its medical records system, Epic. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, found and repaired issues with the system build, and created opportunities for cross-training and centralized reporting.   Long-lasting results   Through this automated process, the healthcare organization now has detailed insight into its claims management process and can monitor rejections data, review effectiveness, and find ideas for even more system automation.   Through its partnership with Experian Health, this healthcare organization has improved its claims metrics across the board. It improved its acceptance rate by 10 percent, and it became an Epic top performer for claims acceptance, averaging a 99 percent acceptance rate. It has also increased its clean, paid claims percentage by over 10 percent.   Start automating to streamline your claims process.

Chalk it up to the rise of high-deductible plans or decreasing payer reimbursements, but the numbers don’t lie: patients are footing more of their healthcare bills and hospitals are struggling to collect. In fact, a recent TripleTree report revealed there has been a 69 percent increase in consumer payments due to providers over the past four years. That same report also noted providers collect only 1/3 of patient balances larger than $200, with the balance being sent to collections or written off as bad debt. All this to say … collections can make or break a hospital. So, how are hospitals compromising on their collections game? Let us count the ways: 1. They treat all patients the same. Some patients may be able to cover all their care costs up front, while others need to spread out payments, or perhaps get help from a lender or charity. Logical, right? But for some reason, many hospitals take a one-size-fits-all-approach to their collections work. They’ll simply submit the bill, wait for payment and see what happens. If payment fails to come in after repeated attempts, they send the account to collections, and the agency often takes a similar approach. Scoring and segmenting patient accounts based on who has the propensity to pay –and directing them to the in-house or outsourced team most likely to collect – is a much more productive collections strategy. Even better, providers should try to determine what patients owe before a procedure, and reveal payment plan options from the start. By developing a means to estimate the cost of a patient's care, providers can deliver a figure to target for pre-operative, pre-procedure collection. 2. They lack an agency strategy. Just as hospitals can take one-size-fits-all approach with their patient collections, so too can be the case with their collections agencies. Some hospitals find themselves struggling with how to reconcile accounts placed with their agencies. Others are unhappy with their early- or late-stage collections vendor, but can’t quite pinpoint where it’s all going wrong. Advocate Aurora Healthcare, an operation with 27 hospitals and 500 outpatient locations, was trying to oversee 20 different collections agencies just a few years ago. They wanted to reduce the number of agencies doing their collections work, and gain a clearer understanding of who was performing best, but they lacked the data insights to evaluate. By tapping into a collections optimization platform, Advocate Aurora was able to reduce their agencies from 20 to four, and they started seeing double-digit increases in their patient collections. Routing accounts to the optimal collections resources, and using collection agencies judiciously, minimized their collection costs, and helped them stay focused on patients who can and will pay. 3. They rely on limited data sources. To create a truly effective collections strategy that is both predictive and insightful, hospitals need to rely on data sources that offer breadth and depth. Let’s consider an example. In the credit world, financial services companies can be looking at two consumers with identical credit scores and come to the conclusion that they should treat each the same. But with more data insights, a lender might see that one is trending up, making on-time payments that exceed the minimum balance, and the other is trending down, showing signs of payment distress. With historical data and other insights, the financial lender would likely treat each of those individuals differently. Agree? The same scenario can unfold in the healthcare space. If providers are solely looking at zip code data, or historical healthcare data, they will be challenged to offer personalized payment plans and decisions around how best to collect. Combining various data sources, including credit data, can provide hospitals with deeper insights into a patient’s propensity to pay and financial disposition. This allows healthcare organizations to identify the best financial pathway for each patient at, or before, the time of service, and will ultimately optimize their account receivable performance as well. — By flipping the switch on a few of these strategies, hospitals can turn their patient collections game around. They’ll see gains in patient satisfaction, improvement in the accounts receivable bucket and the power data can have on segmentation. There’s really no excuse to fail.