Claims denials put a big dent into the budgets of healthcare providers – something many organizations can’t afford today given the current pandemic. In an environment where everyone must do more with less, reducing claim denials could release vital revenue and staff time to create breathing space for quality improvement. The good news? About 90% of claims denials are preventable when healthcare providers automate revenue cycle functions. In fact, providers could gain an estimated $9.5 billion by automating the claims management processes. Here are 5 ways for providers to proactively reduce claim denials. Healthcare providers should shift from reactive to proactive claim denial management, looking at the whole RCM process. On the front-end, that includes streamlining the patient registration process. By achieving near-perfect levels of accuracy on the front-end, providers can prevent costly claims denials and unnecessary re-work on the back-end of the revenue cycle. On the back-end, ideally, providers will use technology to prevent denials in the first place, improve processes for managing denials when they do occur, and then use a robust analytics platform to understand what went wrong so it can be avoided in future.

The manual process for fielding scheduling calls isn't an easy one. Calls can take up to 20 minutes, and call center agents may have to comb through binders or spreadsheets of provider calendars and scheduling rules to book a single appointment. As a result, call center staff may only be able to place a handful of patients per day, despite receiving hundreds of scheduling calls. This not only contributes to a poor patient experience but can cause care delays and potentially push patients to seek care from surrounding competitors. Prior to working with Experian Health, call center agents at Heritage Medical Associates were manually scheduling patients with the process described above, and only able to place three to five patients per day with calls lasting several minutes. With Experian Health’s call center scheduling solution in place, call center agents now have access to all of the organization’s 135+ providers in a single digital platform. With an integration with Allscripts, call center agents can see all available appointments in real-time, identify the best provider and appointment for a patient’s specific care need and then book the appointment on the spot. Heritage Medical Associates has seen several improvements since working with Experian Health. Increased call center efficiency. The time spent on the phone for scheduling an appointment has been nearly cut in half — from seven minutes down to just four. With more time, call center agents can now place between 40 and 50 patients per day. Improved patient experience. Patients who called in to book an appointment, reported higher levels of satisfaction as they were able to navigate to the right provider and appointment more quickly. Enhanced physician satisfaction. By automating their scheduling rules, providers can ensure that any open appointment slots are booked according to their personal preferences. They can better predict their schedules and maintain control over their calendars with the new solution. Improvements to the bottom line. As each individual provider and separate location becomes more efficient, Heritage Medical Associates as a whole has been able to control overhead and has seen quantifiable improvement to its bottom line. “The physicians that I’ve talked with so far find that they have a more efficient and planned day, and it’s more relaxing. Their productivity is increased, and, at the same time, they’ve been able to reduce some of the stresses of their schedule.” — Jim Browne, Chief Executive Officer, Heritage Medical Associates Learn more about how you can improve call center efficiency and the patient experience with guided search and scheduling.

The revised medical necessity form will be mandatory starting January 1, 2021. Here's what’s changed and what providers can do to prepare.

Halloween might be over, but healthcare fraud – or simple input errors – can transform a patient’s identity into something completely different. The negative impacts are potentially far-reaching, haunting both patients and providers. Is the patient standing in front of you really who they say they are? Learn more about Experian Health's identity management solutions and how we can help you match, manage and protect patient data with:  

A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch?

“It’s important to provide our patients with the absolute best access channels to quickly and seamlessly connect with the care they need. Experian Health’s solution guides our patients to the right care and digitally connects them with a confirmed appointment.” - Kaci Husted, Vice President, Benefis Health System It’s shouldn’t come as a surprise that patients today want their healthcare experience to mirror the flexibility and convenience that they are now accustomed to with other industries. Notably, patients want easier and faster access to care, and preferably without having to pick up the phone to call and make an appointment.

In previous winters, anyone struck by a sore throat or fever might assume they had flu, and head to bed with a hot drink and some painkillers. This year, the looming specter of COVID-19 could prompt those with flu-like symptoms to seek medical care instead. Combined with a likely second wave of COVID-19 cases as lockdown requirements relax, healthcare organizations anticipate a surge in patients seeking tests and treatment this winter.

While all hospitals and health systems will no doubt encounter revenue-specific challenges related to the pandemic, a solid foundation and targeted approach for improved collections can help speed up the road to recovery. In fact, it was Sanford Health’s unique approach to increasing patient collections that allowed it to both optimize collections during the pandemic and improve employee satisfaction and retention. Several years prior to COVID-19, Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies. Leveraging Collections Optimization Manager and PatientDial from Experian Health, Sanford was able to quickly and easily streamline call center operations and increase collections in a myriad of ways – through new and updated patient addresses, patient-friendly billing statements, identifying new guarantors and more. With the above items in place, Sanford was already well positioned to seamlessly manage normal business operations during a pandemic. The organization was able to quickly adapt, and then build on that momentum to better serve its patients and staff, while also driving results. Since the start of COVID-19, Sanford has: Increased employee satisfaction with remote capabilities PatientDial allowed Sanford to seamlessly transition its call center team to work remote. Where about 30% of the workforce was remote prior to COVID-19, just shy of 99% of call center representatives are now remote. This has been a great source of employee satisfaction and safety and has aided in the system’s ability to keep the collections momentum going. Provided a more compassionate approach to collections Recognizing that this is a sensitive time for many, Sanford ensured the proper mechanisms were in place to identify those who required additional help, offering the best methods for collection possible. Sanford has not only created a billing indicator for patients affected by COVID-19, but Experian Health has provided additional insight with a weekly file of patients who are identified as possibly financially stressed. Improved collections during time of crisis While collections decreased for the quarter, Sanford saw a record increase in collections for the month of March -- $800K more than the system saw in March of 2019.

Before working with Experian Health, call center operations at Sanford Health were disparate and disjointed, with each call center operating on a different phone system with different carriers. While some centers saw high abandonment rates, others were waiting around for calls. Although Sanford attempted to create balance by placing accounts in a work queue, the process for managing outbound collection calls remained manual and it was impossible to identify and strategically contact patients based on ability to pay. Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies. Since working with Experian Health, Sanford now has a focused approach to managing accounts receivable (AR) by identifying patients with a certain propensity to pay. Collections Optimization Manager allows Sanford to quickly identify a pathway and delivery to resolution of the patient’s balance. The analytical segmentation models within Collections Optimization Manager use precise algorithms that reveal those patients who likely are eligible for charity services, those who might prefer to pay in full at a discount, or those who might benefit from a payment plan. The solution then feeds segmentation data to PatientDial, which Sanford uses to route calls to 70 patient account representatives. Sanford also implemented a re-designed, more user-friendly patient statement format. The improved cover page offers easy-to-understand information about the bill including the available options for payment. In a larger effort to improve the patient experience, Sanford implemented an employee incentive program that appropriately rewards staff based on their collections’ performance. Since working with Experian Health, Sanford has seen the following improvements: Streamlined call center operations. With PatientDial in place, Sanford was able to consolidate its call center team members in 4 regions and seamlessly operate on centralized toll free and direct dial numbers. Where it used to take on average 56 seconds for a call to be answered, calls are now answered in 20 seconds or less. The system now comfortably manages an average of 12,000 inbound calls weekly. Increased collections. The model in place has allowed Sanford to improve collections in a myriad of ways. In addition to increased collections from calls made through PatientDial, Sanford was able to see an additional $2.5M in patient payments by ensuring patient statements were sent to the new or correct address. The system found an additional $60K by identifying new guarantors for accounts of deceased patients. The segmentation capabilities from Experian Health also enabled Sanford to identify patients struggling with bankruptcy, allowing staff to focus their efforts on collectible accounts and more efficiently direct individuals to charity options. Learn more about Sanford Health’s journey and how a similar approach could help your organization improve collections and employee satisfaction.