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US hospitals have provided more than $702 billion in uncompensated care over the last two decades. To protect profits, healthcare organizations must be vigilant about finding any available insurance coverage for their patient’s care. But for many, recent regulatory changes and pandemic-related disruption have made navigating an already complex reimbursement landscape even more challenging. Checking for missing insurance coverage and chasing payments consumes staff time that could be better spent elsewhere. However, with the right revenue cycle management tools, healthcare organizations can reduce profit-eating write-offs and denied claims. Experian Health’s new white paper sets out an end-to-end strategy to help healthcare providers find missing and forgotten coverage. With a comprehensive game plan for minimizing lost revenue at every touchpoint in the patient journey, providers can optimize the patient experience, reduce revenue leaks, and ease the burden on staff. Here, we explore some of the trends that are challenging reimbursements, identify opportunities to find missing coverage quickly, and present best practices to eliminate the risk of bad debt at every stage of the patient journey. Trends that make revenue recovery tougher Healthcare providers must keep abreast of regulatory changes that affect the reimbursement process, which often challenges profitability. For example, the American Rescue Plan Act of 2021 made some key changes to the Affordable Care Act. This included expanding Medicaid provision, decreasing Medicare premiums, and accelerating the COVID-19 vaccination program. For providers, this means an influx of patients who are newly entitled to government assistance, requiring new processes to avoid delayed claims and payments and recover Medicare debt. Many of these measures are a response to the pandemic. COVID-19 has squeezed household finances, leaving some patients without jobs and access to health insurance. Although employment rates are showing signs of recovery, tracking coverage as patients start new jobs remains highly resource-intensive for collections teams. Chasing self-pay revenue can often be more expensive than writing off the initial bill. The growing focus on price transparency may mitigate some of these challenges. Proactive patient engagement can help patients understand and plan for their bills while improving the overall patient experience. The No Surprises Act, effective January 1, 2022, aims to protect patients from unexpected bills for out-of-network care in emergency and non-emergency settings. The regulation protects patients but creates significant work for providers to modify existing processes and systems in order to meet compliance standards. Dustin Whittier, Senior Director of Product Management at Experian Health, explains that automating early coverage checks can be an efficient way to help consumers manage their changing healthcare obligations. He says, “With the increase in high deductible plans, the urgency surrounding COVID-19, regulations such as the No Surprise Act and Notice of Care, and a strategic focus on patient satisfaction and transparency, the impetus to automate knowing the full scope of insurance coverage – as  close to the point of care as possible – has never been greater.” In 2021, Coverage Discovery tracked down previously unknown billable insurance coverage in more than 27.5% of self-pay accounts. The Experian Health team can help healthcare organizations keep on top of changing regulatory requirements and implement solutions that ensure compliance, improve the patient experience, and protect against uncompensated care. Optimizing for revenue recovery at every step of the patient journey Successful revenue recovery starts with a patient engagement strategy that simplifies the steps to reimbursement at every patient touchpoint. A three-pronged approach can increase the likelihood of payment by identifying the opportunities to check for coverage before the patient comes in for care, at the time of service, as well as aftercare. 1. Pre-service insurance coverage checks Verifying and tracking the patient’s insurance status before they come in for care means their financial obligations will be clear from the start. Advance knowledge makes it much easier for patients to plan – and pay ­– their medical bills. An automated coverage identification solution such as Coverage Discovery can scan patient information as soon as they schedule an appointment to find any previously unknown coverage, using multiple proprietary databases and historical information. 2. Identifying coverage at the point of care When the patient receives their treatment, Coverage Discovery can check for any billable commercial and government coverage that may have been missed during pre-service. Providers should also give patients opportunities to pay for care at this point too, to avoid the need to chase for payments later. A simple and quick payment experience can reduce the risk of additional A/R days and collections agency fees. 3. Post-service checks for unidentified coverage Finally, for any accounts that haven’t been settled at the point of care, providers should run further coverage checks before determining whether to send statements and payment reminders to the patient, to write the amount off as bad debt, or to engage a collections agency. Coverage Discovery can detect any discrepancies that could lead to denied claims. It also offers weighted confidence scores so that accounts are reclassified and rebilled appropriately. Automated scrubbing can eliminate manual processes so staff can use their time more efficiently. These steps will help plug revenue leaks at every stage of the patient journey. Not only will that improve cash flow and reduce the risk of bad debt, but it also helps create a more satisfying patient experience. Learn more about how Coverage Discovery helps recover revenue throughout the patient journey and gives patients peace of mind.

According to a recent survey by PYMNTS, many patients want digital healthcare management tools. 76% of survey respondents said they were “very” or “extremely” interested in using at least one digital method to manage interactions with their healthcare providers, rising to 86% among younger patients. This finding echoes Experian Health’s research from our State of Patient Access 2.0 survey. In this survey, we found that the pandemic had cemented consumer expectations around convenient access to care. Providers that wait too long to open their digital front door risk losing consumers to competitors. The “digital front door” describes how a patient can find and access care through online and digital channels. This can include everything from booking appointments and virtual waiting rooms to contactless payments and telehealth. It’s more than just patient access: digital technology can create convenient and connected patient experiences throughout the entire patient journey. The goal is a patient experience that flows seamlessly between in-person interactions and virtual touchpoints, from finding care to post-visit follow-up. Experian Health’s clients revealed that many have embraced digital tools to deliver a patient experience that matches consumer expectations, driven in large part by the pandemic.* Some are planning to invest in their digital front door within the next year, while resource constraints are hampering others in moving forward. Healthcare providers in the early stages of digital transformation may be wondering where to start. Where should they focus limited resources for the biggest gains? The four opportunities that could offer the greatest return on investment are online scheduling, omnichannel communications, contactless payments and productivity-boosting automation. Help patients find and book appointments with easy online scheduling Last year’s State of Patient Access 2.0 survey found that nearly eight in ten consumers prefer to schedule their own appointments at any time, from any device. This trend is set to continue in 2022 and beyond. Many patients have been using online scheduling platforms to book COVID-19 vaccinations and tests, as well as to reschedule care that was delayed during the earlier months of the pandemic. Opening the digital front door with online scheduling offers patients the control, convenience and choice they desire. No-shows are less likely, which leads to higher physician productivity and satisfaction, greater efficiency, lower costs and better patient outcomes in the longer term. Communicate through patients’ preferred channels to boost engagement With the pandemic necessitating so many rules around daily activities, limits on how and when consumers communicate with their providers can feel even more restrictive. Many don’t want to be forced into phone calls at inconvenient times, especially when a simple text reminder or a quick check of their patient portal would do the job. Providers that allow consumers to customize their patient access experience and engage through their preferred channels will be rewarded with increased patient loyalty. Omnichannel solutions also help to build a consistent care experience. A digital process that looks and feels the same every time, regardless of which platform the patient uses, will make navigating the care process much easier. Additionally, patients will be more likely to schedule appointments and fill out forms in a timely manner on their own, which can alleviate staffing resource constraints. A digital front door can help with contactless payments One part of the healthcare experience that can be notoriously tricky to navigate is paying for care. PYMNTS found that 63% of patients would consider switching healthcare providers over a bad payment experience. Providers can make it easier for patients to pay by offering upfront estimates of what the patient’s portion of the bill is likely to be, running automated coverage checks to make sure no insurance is missed, and sending automated reminders with links to contactless payment methods. According to PYMNTS, less than 20% of patients pay for care before or during their visit. However, if providers made it easier to pay, this percentage would likely shoot up. By offering patients their own mobile financial advisor, they can pay bills and access appropriate payment plans right from their phones. It’s convenient for patients and could help reduce delayed payments. A digital front door can improve patient access and relieve pressure on staff A digital front door doesn’t just open up opportunities for patients; it can increase efficiency and improve staff workflows. Healthcare staffing shortages have put immense pressure on providers to find new ways to automate repetitive tasks and relieve staff burnout while maintaining high-quality patient care. For example, automated scheduling algorithms can optimize patient flow and anticipate bottlenecks, so staff can allocate resources more efficiently. Registration forms that are pre-filled with a patient’s information are less prone to errors, compared to manual processes. Automation helps link the digital front door to the front and back offices, which can speed up workflows, support better care coordination, and create a more consistent patient experience. A high-quality digital patient experience should be built on consumer choice, control and convenience. A digital front door is more than just adding a few online tools or sending some well-timed automated texts; it should be at the heart of the entire patient engagement strategy. By investing in digital solutions that leverage the technology already used by patients and staff, providers can offer a stand-out patient experience and improve collections performance. Contact Experian Health today to find out how digital health solutions can help your organization deliver the best patient experience possible. *Survey of Experian Health clients, October 2021 Are you an Experian Health client? Then we invite you to join our Innovation Studio research community. Your ongoing input is key to driving improvements to our tools and products! Sign up here!

The COVID-19 pandemic has highlighted the need for a more responsive, flexible and resilient approach to revenue cycle management, underscored by provider staffing shortages across the country. Automation is gaining momentum as a way to address the staffing issue while improving efficiency and collections optimization to levels better than those prior to the pandemic. Furthermore, with the No Surprises Act effective as of January 1. 2022, automation and digital tools can help providers deliver transparent pricing with real-time cost estimates. With automated healthcare collections, providers can help patients plan for their healthcare costs. This is especially important, given that half of Americans currently have unpaid medical bills. In North Carolina, Novant Health is already seeing an impressive return on their investment in automated patient collections technology. The provider logged over 5.8 million medical encounters in 2020. Novant Health’s patient finance team wanted to address growth while continuing to deliver an improved patient financial experience. They wanted to automate workflows and processes to reduce the need for staff intervention, using a wide-ranging platform that would easily integrate with Epic and provide robust reporting and insights. Compiling agency performance reports for 21 agencies each month was another cumbersome task, so the team also wanted a partner who would help elevate and monitor agency performance. Watch our webinar with Novant Health to see how they used Collections Optimization Manager to increase patient collections and create better patient financial experiences. Delivering a “human experience” with the right patient collections partner Wendi Bennett, Director of Patient Finance at Novant Health, said it was important for them to find a strategic and collaborative partner who would understand their commitment to providing a remarkable patient experience: “The patient can have a wonderful clinical experience but face a financial experience that falls short of expectations," said Bennett. "We wanted a dedicated consultant who would recommend best practices and provide valuable industry insights, and a system with proven results in back-end automation, operational improvement and analytical performance. We were looking to propel our patient experience to the next level and that’s why we partnered with Experian Health.” Automated healthcare collections insights for a better patient experience and fewer unpaid medical bills Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, is the Collections Consultant who has been working with Wendi’s team to implement the Collections Optimization Manager. Cari explains how the Collections Optimization bundle delivers the data insights and execution support that Wendi and her team were looking for: “We’re able to extract data from the facility’s accounts receivable file and produce robust analytics and insights. That allows us to screen or scrub out those accounts that we should not be scoring or segmenting. Then, we shift to the customized segmentation which provides the client the ability to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.  Customized segmentation also gives the client the ability to keep the best, most collectible accounts in-house longer and give the lower yield accounts to their early out agency sooner. We drive revenue back in the door by focusing on these accounts. Finally, we monitor for new insights into patients’ propensity to pay. And with Collections Optimization Manager, our clients receive consultant support as part of the bundle, who provide best practices, insights and analysis throughout the relationship.” Highly predictive patient segmentation means that Novant Health knows which patients are most able to pay, those eligible for charitable support, and who should be directed to different payment plans. This supports more compassionate financial conversations and communications with patients. It also creates opportunities for personalized recommendations, such as reminding new parents to ensure their child is included on their healthcare insurance. The more transparency, simplicity and compassion that can be built-in, the easier the process will be for patients. For providers like Novant Health, that means fewer bills being written off. Efficient allocation of patient collections staff resources Collections Optimization Manager also allows providers like Novant Health to focus their efforts on the right accounts. It doesn’t make sense for staff to spend valuable time following up with patients who have a low co-pay amount and a high likelihood to pay. Simple automated reminders address that situation. The Novant Health team used automated dialer campaigns to reduce manual outbound calls and allocated limited staff resources to more complex accounts. A split-screen shows staff all the information they need during the call, eliminating the need to log into multiple systems at once. Call recordings stop automatically before the patient shares their credit card information, ensuring PCI compliance without extra steps. Keeping track of collections agency performance – and costs With Collections Optimization Manager, Novant Health can prioritize high propensity-to-pay accounts in-house, which helps to manage agency costs. A customized scorecard and dashboard keep track of agency benchmarks, giving the executive leadership team a real-time snapshot of performance, informing decisions about vendor management. The Compliance Manager function helps Novant Health ensure agency collections have compliance at top of mind and are not solely focused on the highest yield accounts. This function, combined with better segmentation and a higher call connection rate, results in higher recovery rates. With Collections Optimization Manager, Novant Health has seen a 5.8% increase in unit yield year-over-year, and an overall recovery rate of 6.5%. Overall increased revenue and cost savings amount to an impressive rolling average return on investment – 8.5:1. Watch the webinar to find out more about how Novant Health boosted its patient collections recovery rates with an automated healthcare collections platform. Find out more about how Collections Optimization Manager can help your organization use automation and digital tools to create a more efficient patient collections process and a more streamlined patient financial experience.