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Healthcare staffing shortages are patients' biggest safety concern, according to a new study by ECRI. Pandemic pressures led many healthcare workers – clinical and non-clinical – to join the “Great Resignation,” causing a significant drop in hospital employment since February 2020. Insufficient staffing can lead to longer wait times and clinical and administrative errors, which can present a real threat to patient safety. Critical shortages also erode financial performance through wage inflation, recruitment and training costs, and hampered productivity. As the problem persists, providers are seeking effective solutions to alleviate the burden on their existing workforce and solve for healthcare staffing shortages. Digital tools and automation should be top of the list to help improve efficiency, increase staff satisfaction, and corral the resources needed to deliver high-quality care in a cost-effective way for non-clinical jobs. Creating the conditions for a thriving healthcare workforce The pandemic exacerbated longstanding issues with understaffing and burnout that led to healthcare staffing shortages, but it also expedited several digital innovations that may be part of the solution. An aging population coupled with increasing public health concerns aren't going to make the situation any easier, so healthcare leaders should leverage these digital advances to build a resilient workforce. For non-clinical roles, advanced data analytics and automation can complement wider workforce strategies – by making it easier for downsized teams to do more with less. This can help reduce time-consuming manual work, eliminate frustrating and unnecessary rework, and streamline workflows to increase efficiency and job satisfaction. By handing off repetitive and rule-based tasks to intelligent software, administrative and billing teams will be able to manage the growing workload with less staff and focus their efforts on the tasks that really need a human touch. How digital tools can fill in the gaps created by healthcare staffing shortages 1. Streamline non-clinical workflows with advanced analytics Analytics can capture organization-wide insights to inform planning and optimize staff resources on a day-to-day basis. By taking a deep dive into existing processes, providers can better understand what tasks are really necessary. Eliminating superfluous activities and automating those that don't need a human touch means that available staff can be deployed more efficiently. This is more than simply digitizing existing workflows. The real power lies in combining updated technology with strategic process improvements. For example, automated patient outreach allows providers to send automated messages and appointment and bill reminders to patients, so fewer staff members are needed to manage calls. It can also be used alongside consumer data to segment patients according to their needs, so providers can identify and reach out to those that may need to reschedule care. This can help forecast future demand with greater accuracy. 2. Facilitate self-service patient access with automation Equipping patients with the digital tools to complete more administrative tasks themselves is another effective way to reduce the need for staff input. Self-service patient scheduling and registration solutions give patients the convenience and choice they desire (as revealed in Experian Health's State of Patient Access survey 2.0). They also minimize the manual tasks and call volumes that put pressure on understaffed patient access teams. Digital scheduling also plays a role in patient care. Online scheduling reduces the risk of no-shows because it's easy for patients to book and reschedule appointments at a time they know they can attend, thus avoiding diagnostic and treatment delays that could lead to poorer health outcomes. And unlike manual registration processes, data errors are far less likely, which helps avoid delays and rework later. Automated self-scheduling and registration platforms allow small teams to handle more complex work, which improves staff satisfaction and increases the likelihood of positive patient outcomes. 3. Let better data minimize staff time spent on revenue cycle tasks Understaffed teams must allocate their time carefully. Significant amounts of staff time can be saved throughout the revenue cycle with more accurate and timely data. For example, Kootenai Health in Idaho saved 60 hours of staff time in two months by automating patient financial clearance. More patients were assigned to the correct financial pathway, and reliable data insights helped reduce manual work and guesswork, leading to fewer bills being written off. A particular challenge for busy teams is managing frequent changes to prior authorization requirements. Prior authorization software pulls information from multiple health plan websites to give staff real-time visibility into current requirements and generates an exception-based workflow so they can focus on high-priority tasks. Ease workforce pressures and enhance the patient experience with automation Automation is not a substitute for the care and attention provided by expert healthcare workers. However, new digital and data-driven technologies can complement person-to-person interactions and ease pressure on busy teams. Integrating reliable data sources, analytics and responsive workflows can help providers manage current shortages and future workforce challenges by removing unnecessary manual tasks, reducing errors, and offering insights to improve patient-facing and back-office systems. Contact us to find out how Experian Health's data-driven insights and automation can help solve for healthcare staffing shortages, protect the revenue cycle and maintain high-quality standards of care.

The payer policy rollercoaster has taken a few twists and turns recently, leaving healthcare organizations out of the loop if they try to keep pace with payer requirements using manual systems alone. Keeping track of changing payer requirements has long been a major challenge for providers, but several shifts in the reimbursement landscape have prompted payers to implement updates at rates providers may struggle to match. More flexible policies permitted during the pandemic are being rolled back, altered employment patterns are influencing insurance plan administration, and new clinical delivery models (such as telehealth) are necessitating different coding structures. Healthcare providers that fail to keep up with these changes could end up wasting many hours and resources to rework claims. Instead, they should consider using automated payer alerts to ease the administrative burden, keep a lid on denial rates and protect profits. Automated payer alerts give providers the power of knowledge For many providers, staying on top of payer requirements involves recurring calendar reminders to check payer websites, subscribing to payer newsletters or social media accounts, or poring over industry media coverage for a hint at possible changes to come. If these checks were automated, providers could save hours of valuable staff time, and feel confident that no vital details are missed. With automated Payer Alerts, providers get instant access to the payer policy and procedure changes they’re too busy to catch. It’s a simple and convenient way to monitor modifications so claims can be submitted correctly the first time. This means staff can spend less time researching changes to procedures. Through an online portal and daily email digest, providers get timely alerts about payer changes posted on more than 120,000 different web pages. Every notification is the result of extensive behind-the-scenes work by Experian Health’s proprietary software. The program generates alerts with a detailed summary of changes, a link to the affected policy and a breakdown of changes by healthcare specialty. This allows providers to prioritize those that are most relevant to their organization. Client success story: Payer Alerts pay big dividends Being in the loop about what’s covered and what’s not puts providers in a better position to protect revenue by enabling more efficient allocation of resources, minimizing claim denials and avoiding missed revenue opportunities. New York-based University Physicians Network (UPN) implemented Payer Alerts to help physicians avoid denied claims. The CEO said, “Payers are increasing their edits, but if you know about them ahead of time and can make the required adjustments, you can avoid both denials and time-consuming appeals. With Experian Health, we now have an automated, straightforward process that helps us minimize unnecessary denials and take a proactive approach.” One UPN group recovered $42,000 as a result of a Payer Alert on a single policy change. Amplify results with the right healthcare payer solutions Payer Alerts helps healthcare organizations streamline their workflow and maximize revenue through more than just its immediate features. Its compatibility with other automated healthcare payer solutions can build the perfect defense against payer reimbursement challenges. For example, combining Payer Alerts with Contract Manager and Contract Analysis helps hospitals manage multiple payer contracts and checks that the correct amount has been reimbursed. Contract Manager allows providers to monitor payer performance and arms them with the data to negotiate more favorable contracts. It generates reports that support better communication with payers. This results in fewer phone calls to resolve issues and reduces the likelihood of misunderstandings over patient insurance status or whether a claim was received. Similarly, Claim Scrubber works alongside Payer Alerts to review every claim and verify that it’s coded correctly before being sent to the payer, to reduce the risk of denials. Claim Scrubber also now includes billing modifiers designed to support compliance with the Appropriate Use Criteria program. Using Payer Alerts to keep pace with regulatory changes Looking ahead, providers must continue to pay attention to legislative changes that affect payer strategies. Implementation of the No Surprises Act and related legislation should lead to greater transparency and more effective data sharing within the healthcare community. However, it also puts pressure on payer-provider relationships. Payer rules may continue to change, which means that payers may interpret these rules differently. Experian Health’s regulatory solutions can help providers stay on top of these changes and avoid penalties. Ultimately, providers can’t respond to changing payer policies if they don’t know those changes have been made. While change is inevitable, losing valuable time and revenue to inefficient manual processes is not. By investing in automated healthcare payer solutions, providers can adapt to change and stay ahead of the game. Find out more about how Experian Health’s Payer Alerts can help healthcare organizations capture the necessary information to make timely and strategic decisions to protect profits.

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.