How long will providers be able to tap into CARES uninsured reimbursement benefit for COVID care?

Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. Shots may be free to patients, but someone has to pay for them – and getting reimbursed is proving to be a major pain. Complicated billing processes, extra billing audits and mountains of extra paperwork, rejected claims and slow payments are not exclusive to pharmacies helping vaccinate America. With the coronavirus pandemic continuing to muddy the insurance landscape, getting hold of missing dollars is challenging. Healthcare reimbursements haven’t been straightforward for other providers either: widespread coverage loss and uncompensated care is putting extra strain on hospital revenue cycles. With the coronavirus pandemic continuing to muddy the insurance landscape, getting hold of missing dollars is challenging. Providers must find ways to quickly and accurately determine each patient’s coverage status to minimize bad debt. Navigating the complex world of post-COVID healthcare coverage What does the reimbursement landscape look like, one year on? After a long wait, elective procedures are back. But the surge in patient volumes means providers must be on their toes to keep track of coverage. The process for doing so must be streamlined and precise. Ramping up capacity to verify and check coverage without burdensome paperwork is a must. Patient intake is under pressure. More patients are coming through the doors as a result of elective services and vaccination programs (though not always to their usual facility). COVID-19 hasn’t gone away, and with pockets of infection spikes, safety remains a top priority. Capturing adequate insurance information in this context is no mean feat. Running automated coverage checks as soon as the patient arrives will minimize face-to-face contact during admissions and avoid delays. Patient access and collections staff are overburdened. Manual checks are difficult when staff are operating remotely or in a socially distanced environment, and patient information might be incomplete. Automated self-pay scrubbing can help handle the volume. A tool with built-in reporting can also offer insights on workflow and productivity, to help spot opportunities for quicker claims processing. New digital healthcare technologies aren’t always covered by insurers. Telehealth, a life raft during COVID-19, tends to be covered less often by private insurers, compared to Medicare and Medicaid. Coverage checks must factor this in to avoid errors and wasted time. Providers should opt for tools that sweep for payer updates to telehealth coverage to avoid unnecessary delays or denials. Employment levels may be inching upwards again, but tracking coverage remains a challenge as patients start new jobs with new health plans. In addition, checking for Medicare coverage in the midst of changing codes and protocols is time consuming and confusing. A third-party resource such as Coverage Discovery can look for all coverage options and make sure the right bill goes to the right payer. Find missing dollars with Coverage Discovery Hospitals, pharmacists and other healthcare providers can’t afford to continue losing money at a time when every dollar is needed to prepare for “after COVID-19.” Experian Health’s Coverage Discovery is a proven system for tracking down missing coverage quickly and easily, to avoid unnecessary revenue loss. Using billions of data assets and intelligent confidence scoring, it combs through multiple government and commercial payer accounts to maximize actionable coverage. Staff can trust the outputs and focus their attention where it’s really needed. By making coverage identification more efficient and accurate, it’s a shot in the arm for providers in need of faster reimbursements. Contact us to see how Coverage Discovery can be easily integrated into your revenue cycle, so you can maximize reimbursements over the coming weeks and months.

Published: April 13, 2021 by Experian Health

  Read the previous blog post in this Q&A series on segmenting patient populations for the COVID-19 vaccine. There are a lot of unknowns in the COVID-19 vaccine management process, which makes the rollout and administration of this vaccine even more challenging. Many providers are in the dark about how many vaccines they will get, they don’t know which patients to include and in what order and they aren’t sure how to keep staff from being overwhelmed. We interviewed Sanju Pratap, vice president of product management for consumer products at Experian Health, about what specifically is so challenging for scheduling the vaccine and what providers can do to prepare. What about the vaccine scheduling solution function is challenging providers? The unpredictable nature of available vaccines is a large part of what makes the scheduling for these vaccinations so difficult. Before now, providers haven’t had to manage mass quantities of appointment slots and related registrations and billing. And even with those features streamlined, providers are still unsure of the best way to reach out to eligible patients, in an equitable manner, to prompt them to schedule their appointment. What have we seen as the most effective and efficient way to schedule those patients for a vaccine? The ability to target patients specifically, either by email, phone or text, who are eligible for the vaccine can make a big difference. It removes a lot of the anxiety on the patient’s end while also making the scheduling experience as simple as possible for patients and staff. But outreach is just the first step. To really streamline the process, healthcare organization’s need to leverage a scheduling solution that incorporates scheduling rules and protocols. This ensures that a set number of appointments every day are designated for vaccinations and patients can see and schedule directly into those slots. When a patient schedules their vaccination through a system like this, providers can better track and recognize who needs to come in for a second dose. They can automate that process, by pushing out a message to the patient to schedule their second dose or offer to schedule that second dose on behalf of the patient before they leave the office using those same scheduling rules & inventory. How can a provider best equip the call center to handle volume and schedule appropriately the individuals who prefer to set an appointment that way? Given the high patient volume, the preferred method is for patients to schedule their appointment online, and for providers to push as much as they can online via self-service tools. This will minimize the initial load on the call center freeing agents to focus on those who truly need to schedule via the phone or need additional help. Even if a patient schedules their vaccination online, the information is shared with the call center which equips agents to help patients schedule their second dose. If or when a patient calls to schedule that dose, all agents need to do is search by first and last name, pull up the information and schedule the next dose on the spot. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?

Published: March 9, 2021 by Experian Health

It’s been almost an entire year since COVID-19 changed life as we know it. The good news? A vaccine has finally arrived and is currently making its way to distribution sites across the United States—a significant milestone as the nation has seen more than 16 million cases to date, and more that 300,000 deaths. Because of the current supply, the Centers for Disease Control are recommending healthcare personnel and residents of long-term care facilities receive the vaccine first. Supply is expected to increase in the weeks and months to come, however, and the goal is for everyone to have access to a vaccine by the second quarter of 2021. As healthcare organizations across the country prepare to meet the vaccine demand, it is expected the logistics and distribution management will add pressure to staff and services already under stress. The challenge: administer the vaccine as efficiently and safely as possible. Online patient scheduling has already been a game changer during the pandemic, but its potential as a traffic management tool to address the influx of vaccine appointment requests is even greater—and not just for patients. In the early stages of deployment, online self-scheduling can be a game changer for healthcare workers and other essential employees looking to schedule and receive the vaccine. Here are four ways providers can leverage online patient self-scheduling for the rollout of the COVID-19 vaccine: Designate day and time slots specifically for administering vaccines By incorporating providers’ scheduling rules into the scheduling process, there is the opportunity to designate specific day and time slots for administering the vaccine. It not only makes it easy for patients to schedule, but it additionally allows both patients and providers to further minimize the risk of unnecessary contact with others in the office. Create screening questionnaires during patient scheduling As more patients go on-site for the vaccine, they must be routed to the most appropriate care source and location. This will prevent unnecessary traffic and bottlenecks in the office, while ensuring the safety of individuals. As soon as a patient begins to book a vaccine appointment a few short questions about their symptoms and reason for booking can be presented. A screening questionnaire like this can triage people wanting to get a vaccine or get tested, and help identify potential COVID-19 positive individuals, and if that individual needs to quarantine prior to coming in for the vaccine. After screening, the system can direct patients through the correct channel of care. Screening questionnaires can also be used to determine if a patient is eligible for the vaccine given the current status of vaccine deployment. Older patients may be given priority whereas younger patients may be told to schedule at a later date. A system like this can also reduce pressure on call center staff and give providers control over the volume and timing of in-person appointments, thus helping to reduce patient and staff exposure to any contagion. Make it as easy as possible for patients to schedule both doses Most of the early COVID-19 vaccines will require shots to be effective, with the second dose being administered 21 to 28 days after the first. It’s critical that the second does is administered in a timely manner. There are a few ways to encourage patients to return. First, providers can help patients book their follow-up appointment in the office before leaving. Second, providers can leverage automated outreach as a method to contact and remind patients to book a follow-up. Experian Health’s Patient Outreach Solutions have been purpose built to meet this need, sending outreach campaigns to individuals enabling them to self-schedule needed care conveniently, right from a text or voice message. Automated outreach would allow providers to reach out to specific subsets of patients that may require or benefit from the vaccine early on, like older individuals or those with chronic conditions. With it, providers have the ability to reach out to hundreds, even thousands of patients without manual call center workload – something that will come in handy as now the majority of Americans plan to get vaccinated for the coronavirus. Improve the efficiency of drive-through vaccination programs For those providers considering drive-through vaccinations (similar to drive-through COVID testing), online scheduling makes a huge difference—not only for booking an appointment, but for preventing bottlenecks as patients arrive. Detailed information such as the patient’s vehicle model, color and license plate number can all be recorded ahead of time during the screening process, allowing providers to quickly identify patients as they arrive. Learn more about the benefits of digital scheduling and how Experian Health can help your organization navigate the rollout of the COVID-19 vaccine.

Published: December 17, 2020 by Experian Health