Tag: claims

Experian Health will be at HFMA ANI again this year–booth 1025–at the Venetian-Palazzo Sands Expo in Las Vegas, Nevada. Kristen Simmons, Senior Vice President, Strategy, Innovation, Consumer Experience, and Marketing, with Experian Health, chatted with Joe Lavelle of IntrepidNOW to provide her insights on this year’s HFMA ANI conference, consumerism in healthcare and much more! Excerpt below: Experian Health booth activities  "[In our booth this year at HFMA ANI, we want to focus] around peer to peer learning and exchanges, so we are doing less selling and more engaging and more understanding. Understanding folks problems and helping to collectively arrive at solutions. We are doing a lot this year in terms of hands on demos of our solutions. We'll be showing some of our patient engagement products which include, self-service portals and mobile options for getting price estimates for applying for charity care, and setting up payment plans. Likewise, on the revenue cycle management side to automate orders with patient access functionality, contract management claims and collections, all those types of things that we do to improve efficiency and increase reimbursement for our clients. We'll also be showing off some of our identity management capabilities to match, manage, and protect patient identities so we can safe guard medical information and reduce risks for our clients. And on the care management side, our early support and sharing of post acute patient care information to help providers succeed as we all move forward into a value based paradigm." How Experian Health is addressing the need for consumerism in healthcare  "When it comes to consumerism, it's interesting when you're a company that has a lot of data and a lot of capabilities to say, 'Hey what can we do for people?' One of the things we really wanted to look at for our consumer approach, was to say, 'What is it that needs to be done?' We had some great hypotheses coming in and a lot of those were borne out but we actually undertook a big national study to take a look at what consumers biggest pain points were. It has a qualitative and a quantitative component. But, we basically looked at the entire healthcare journey so we weren't just asking them about the administrative and financial aspects of care, but also the clinical aspects. As we walked through the journey and were able to get a lot of quantitative data about all these different aspects of their healthcare journey, what actually turned out to be the most painful for the most people, were all the things around the financial equation. And, so clearly there can be pain in a clinical side, especially if you're unhealthy, you've got something chronic, you've got something terminal. There's all kinds of awful situations there but, really affecting almost everyone is a lot of the pain around the financial aspect of healthcare. So, we were able to look closely at some of those pain points and decide on some of the biggest ones that we wanted to tackle." How Experian Health is helping providers address financial pain points for patients and providers "Some of the big pain points for people is just the fact that you don't know what you're going to owe and as the patient portion of responsibility increases, understanding what you're going to be paying becomes more and more important to a consumer. So, understanding what I owe earlier, being transparent, and then helping me pay, those are some of the areas. And there are others but those are some of the absolute biggest pain points. And as you pointed out with some of our propensity to pay analytics, and some of the other capabilities that we have, we're able to help providers understand the financial situation patients are in much earlier in the process so they can get them to the right kind of funding sources. They can give them peace of mind so that they know what they're paying upfront, which may impact when they choose to go in for a major procedure or how they might want to save up for it or how they might want to access different funding sources." Listen to the full podcast

As a healthcare organization, if you're not already focused on decreasing claim denials, time is of the essence. According to one industry estimate, healthcare personnel spend a little more than 20 hours per week solely dealing with insurance claims. Altogether, that equates to about $83,000 worth of time per year per physician on claims-related administrative tasks. Most of those expenses come from needing to rework and resubmit denied claims. For example, the average U.S.-based health plan with 100 million patients processes about 1 billion medical claims annually. Up to 20 percent of these are denied due to poor claims management, and each denied claim costs approximately $25 to rework. It’s obvious, then, that cutting costs and improving productivity means learning to cut down on claim denials, too. This is exactly why Northwell Health turned to Experian Health's Claim Scrubber to accommodate its claims management needs. Cutting claim denials in half The Northwell Health network is intimately familiar with the high costs of dealing with claims denials. The nonprofit healthcare system consists of 22 hospitals and more than 550 outpatient facilities throughout New York state. In 2013, it partnered with Experian Health to cut down the rate of denied claims for all of its providers. With the help of Experian’s Claim Scrubber solution, Northwell Health cut that rate by 50 percent within just a few years. The network now also enjoys significantly shorter times between claim submissions and reimbursement, and staff can more easily stay up-to-date on regulatory and coding changes. By 2017, Northwell Health was a different, much more efficient healthcare network than it was four years before. The change was due mostly to the dramatically reduced time and costs related to denied medical claims, which Claim Scrubber made possible. The key to Northwell Health’s success Simple human error is the main reason why medical claims are denied so often. The smallest typo or discrepancy can lead to an immediate denial, and reworking a claim rarely increases its chances of being more accurate. Claim Scrubber eliminates that error by automatically quality-checking each claim line by line according to general, patient, and payer-specific information. The software solution streamlines claims management by checking that every claim is clean and error-free before the provider submits it, eliminating the costly, time-consuming need to redo them. Fewer denials (and, therefore, fewer reworked claims) mean a faster and more predictable revenue cycle, as well as lower administrative costs and more time for staff to focus on patient care. In turn, by 2017, Northwell Health providers' investment in patient care paid off. They were ranked the Best Children’s Hospitals across nine specialties by U.S. News and World Report. This is an amazing accomplishment, especially when Northwell Health's work with Claim Scrubber began as a small pilot program implemented for a single specialty. At first, the network chose 10 distinct edits to implement in claims related to a single specialty. Through direct communications with the Experian Health team, including weekly invoice audits to ensure the edits were working, Northwell Health providers quickly began seeing results. For that single specialty, claim denials in several categories started decreasing rapidly. After just one year, providers throughout the Northwell Health network saw the difference compared to their own claim denial rates. Before long, every provider wanted the edits enabled for their categories. Today, Claim Scrubber is activated for more than 25 specialties throughout the network, and leadership is confident that denial rates will continue to drop. Take your small step with Claim Scrubber The reason why the Northwell Health network is such a great example of Claim Scrubber’s potential is that it implemented the change in small steps. When it comes to claim submissions, every detail matters, and together with Experian Health’s experts, the solution allows you to examine every detail and the success of each edit before moving on. Change is challenging, especially in healthcare, but the exorbitant amount of time and money that providers lose every year to denied claims is becoming unsustainable. By following Northwell Health’s example and taking small steps toward better solutions, every healthcare provider can overcome that challenge and eliminate the burden of claim denials.

No two healthcare organizations are the same. Each has varied workflows that optimize efficacy and overall care for patients. That’s why healthcare software solutions should never be considered one-size-fits-all approaches. It isn’t fair, or terribly productive, to force healthcare organizations to adapt to new software. Rather, the healthcare software should adapt to them. At Experian Health, we’ll never supply a software product and then expect you to adjust workflows to suit it. Instead, we embed ourselves into your company to ensure we deeply understand your productivity needs and the reasons behind them. Only then can we tailor the solution we provide around you. It’s never too early to get it right The conversation about customizing your healthcare organization's solution begins before you even sign up. As soon as a solution interests you, we’ll start looking at how to tailor it to your unique needs. We’ll hold a meeting that includes subject matter experts and implementation leadership groups to uncover your greatest usability needs. Then, we’ll document those needs to better prepare whoever runs your project and ensure he or she has all the necessary information upfront. Then, gears start moving during the sales process. After choosing a solution, our team of experts works with members from every department in your organization to iron out the appropriate design and functionality details. We believe the people who will be using and relying on the solution every day should have a significant say in these details. However, we’ll do all the legwork of actually building and implementing the solution itself. By the time we’re ready to run internal tests to make sure the software works, members of every department will already know what to expect. Consequently, when they run user acceptance tests to check whether the solution fits into their workflows, they can accurately measure the solution’s performance against their input into its design. Afterward, we can iron out any hiccups they run into before initiating the organizationwide training and “go live” steps of the process. It’s never too late to make adjustments Our deep involvement in customizing your solution also begins before you select it, and it continues long after it's successfully implemented. We don’t go away just because we marked you as “live.” Instead, we understand that the healthcare industry is in constant flux and you might experience operational changes that warrant additional tinkering and tailoring to our solutions. We’ll stick around for a couple of days after going live, and we’ll stay available forever after, just in case. For example, if you purchase a new physician group six months after going live, you’ll face quite an uphill battle onboarding them all into your software system and, in turn, getting them up to speed. Because the group is new, you might face opposition to bringing on any change in general. In this case, you could use help facilitating the training and the adoption of your system into this new group, and that's where we step in. Additionally, what if this implementation requires a work queue structure that’s vastly different from yours? If the new group operates in a different area of the state, they might also have unique rules for some of their payers. These rules have to be incorporated into their system to accommodate the patient population. None of this, though, should fall solely on your shoulders. We can worry about the system's features so you can focus on the operational change management aspect. For our clients, we’re always on call. This devoted availability could range from six months or even six years. Whatever the situation, we know that you’ll eventually face circumstances that your software wasn’t originally designed to address. Instead of feeling stuck and frustrated, clients can find comfort in knowing we are here for every step of the process. And beyond tailoring your solution before implementing it, we also offer continued customization to help you tackle new circumstances without compromising workflow. Overall, here at Experian Health, we understand the pressures facing healthcare organizations today, and we are eager to be partners with you in securing the best solution for you needs and guiding you through the challenges ahead.

For healthcare providers, revenue cycle management has become more important than ever. Due to increasing complexity in the payer mix and patients encountering more out-of-pocket costs, revenue cycle directors are also finding management an uphill battle. To maximize their reimbursement rates, today’s healthcare providers must take control of revenue cycles, and that requires optimizing three particular areas: estimates, claims, and collections. However, this task is much bigger than one person or department to enforce. For success, revenue cycle directors require an array of reliable, automated solutions that allow leveraging a wide range of data and comprehensive analytics with minimal employee input. At Experian Health, we offer a variety of solutions that help optimize healthcare systems' revenue cycle management by simplifying the three key areas mentioned above. Unlock vital revenue cycle management capabilities With patients taking more responsibility for their medical costs, modern revenue cycles are most successful when tailored to patients. This includes providing accurate cost estimates upfront, making sure claims are clean before submitting, and prioritizing debt collection efforts where they are most successful. 1. Patient Estimates: providing accurate estimates early In our consumer-centric environment, patients expect a greater level of insight into the costs of medical procedures, preferably before receiving treatment. No one likes to be surprised months after treatment with medical bills that far exceed what they expected. In addition, state laws now require hospitals to provide more accurate patient estimates. For consistently accurate cost estimates, a healthcare provider must have a dependable price-generation process. For example, the estimates should incorporate a patient’s specific insurance information for accuracy. They should also be compared to the patient’s propensity to pay so a payment plan can immediately be set up, much like how financial institutions treat automobile loans. Patient Estimates, Experian’s price transparency tool, auto-populates much of the necessary data so healthcare providers can deliver accurate patient estimates as early as possible. In turn, consistently accurate cost estimates raise healthcare providers' chances of collecting revenue upfront and help avoid unnecessary headaches during the claims and collections processes. 2. Claim Scrubber: submitting clean claims The conflicts caused by denied claims are expensive to fix. Interactions with payers cost medical groups thousands of dollars per physician each year. Many of those interactions result directly from denied claims, which often stem from inaccurate data. Claims data can be edited in Experian Health's Claim Scrubber, which reviews each claim line by line and makes edits based on the platform's data. Claim Scrubber combines the data with general, payer, and patient-specific information to guarantee each claim is properly coded every time. 3. Collections Optimization Manager: collecting debt strategically and efficiently If a healthcare provider wants to redesign its collection processes to center around patients, it should rely less on random outbound calls and focus more on insight regarding each patient’s propensity to pay. The burden of collecting on past-due balances is a demanding task. It also reduces a healthcare provider's chances of successfully collecting bad debt. One of the most important reasons — among many — to consistently provide accurate estimates and claims is to make collecting debt more successful and less time-consuming. Granted, a healthcare provider can't expect to collect every single outstanding fee. However, by concentrating on patients who are able to pay, a much greater percentage can be collected. Furthermore, Experian Health's Collections Optimization Manager helps complete revenue cycle management by using in-depth collected data to identify patients who are most likely to pay their hospital bills. In turn, staff members can utilize their time and resources more efficiently by contacting these specific patients first. Like most companies, healthcare providers are beginning to realize that patient engagement is a top priority. With this elevated engagement comes the need for consistent price transparency for medical care. Luckily, Experian’s automated engagement solutions can help your healthcare system provide the increased transparency it needs while also optimizing its revenue cycle management.

Recent industry shifts, including the transition from volume- to value- based reimbursement, lower reimbursement and shrinking inpatient margins, increased bad debt due to high deductible health plans and other challenges, are causing undue stress for healthcare providers. It’s difficult for some organizations to manage complex reimbursement models or handle complex claims, so providers are often underpaid or write off revenue they are due. The cost to collect continues to rise when staff produces poor results or turnover is high. Additionally, hospital information system (HIS) conversions traditionally result in a backlog of accounts receivable (A/R), requiring incremental staff to support the conversion. 78% of CFOs are concerned about their revenue cycle platform capabilities for value-based payments and will outsource in lieu of investing in new technology.^ Experian Health's Revenue Cycle Services leverage Experian’s proprietary technologies and experienced staff to optimize revenue cycle management (RCM) performance to help you meet your financial goals, such as increasing A/R yield, lowering operating costs, and resolution of revenue leakage issues and denials. Contact us today to learn more about Experian Health’s Revenue Cycle Services.   ^2015 Black Book Survey

In its first year of consideration, Experian Health’s ClaimSource® solution garnered the 2017 Category Leader title for claims management. This was achieved by having products and customer support that address the top issues in Patient Accounting, including: Declining reimbursement making it more important to ensure accurate payments Slow payment from third-party payers Having to make analytics-based key financial and operational decisions Constantly changing governmental mandates and payer requirements Managing the move from fee-for-service reimbursement to value-based reimbursement The challenge of finding skilled resources The continual stress to do more with less The Experian Health ClaimSource product suite addresses these challenges first by providing excellent products that are all seamlessly interfaced and can provide exception-based processing for: Automation of processing clean claims through the use of an expansive library of national payer edits The ability and willingness to create provider specific custom edits Expediting the follow up process thru the use of enhanced claims status detailed responses Enabling more efficient processing of denials by analyzing denials reasons and automating workflow Automating the payment posting process with customized posting files for handling splits and contractual adjustments Providing the best interfaces available for Epic clients for both hospital and physician billing offices We follow that up by offering superior customer support for our clients. By leveraging our size, experience, and multiple locations in Sacramento, California and our new location in Schaumburg, Illinois, we support clients from Hawaii to New York to Alaska to Florida and everywhere in-between. These two offices allow our clients to get great hands on support for implementations, training, extensive custom programming, as well as experienced billing analysts with decades of billing knowledge. We always thought our claims products stood out against our competition, but now KLAS has validated that for us. Ask your Experian Health account representative or email us at experianhealth@experian.com to find out how we can help your business office address your specific needs.

In the 1930s, Ovaltine offered listeners of the Little Orphan Annie radio program a membership badge with a decoder ring that allowed listeners to replace numbers with letters and figure out secret messages – which usually urged them to drink Ovaltine.. Fast forward to 2015, and a decoder ring can be bought online for under $20. Unfortunately, these trinkets aren’t sophisticated enough to help practices and hospitals decipher reimbursement contracts and identify underpayments. Providers today require robust analytics and automated workflows, coupled with a level of support that goes far beyond an instruction manual to include continual updates to contract terms by skilled contract analysts. According to the American Hospital Association, combined Medicare and Medicaid underpayments were $51 billion in 2013. Private payers further contribute to underpayments, totaling a hefty financial gap for providers, regardless of care setting. It is imperative that providers across hospitals and medical groups take proactive measures to ensure they are paid fully and fairly for the care and services delivered. Incorporating automated solutions enables providers to fully decode the hidden “catches” in contracts while recovering underpayments. Understand how proposed contracts with payers affect your revenues When a payer assures you that proposed contract changes will benefit your organization, are you skeptical? Using contract analysis and modeling, you can accurately predict how a change in any of the hundreds of variables in third-party contracts will affect reimbursement for your precise mix of services. Not only can contract analysis let you see the overall impact of an individual contract, it also lets you precisely model revenues so you can see the gains or losses for each individual specialty, provider or service. By assessing which factors have the greatest impact on your reimbursement, you can refine your bargaining strategy to negotiate better-performing contracts.  Verify the accuracy of payment received from third-party payers Ensuring your contracts are as advantageous as possible is just half the battle; you still have to confirm that payments follow the guidelines of the contract. Complicating this process is the move to new reimbursement structures that bundle payments or base them on value rather than services. Verifying payment accuracy can easily bog down your team–unless you put the benefits of automation to work for you. Contract management and analysis solutions streamline workflow by auditing claims so you spend time only on those that require intervention. Through data-driven insight, you can conduct contract-based appeals and recover lost revenue. Together, these solutions assist in reviewing and modeling contracts, and then accurately identifying, appealing and recovering underpayments. With the ability to value the claims you file and evaluate overall contract performance, you decode the information locked away in data. All without a decoder ring. Don’t miss our upcoming webinar, "Overcoming the Three Ps: Payers Who Pay Poorly” Featured Speakers: Kristen Prenger, Director of Managed Care, Lake Regional Health System Rebecca Charo, Product Director, Experian Health Date: Thursday, May 21, 2015 Time: 11 a.m. PT/1 p.m. CT/2 p.m. ET Register now!

It’s only natural to want to be fairly, fully and quickly reimbursed for services – it’s the basic foundation of business. Yet only in healthcare does attaining this basic transactional norm become challenging. Healthcare providers must be vigilant at all stages in the revenue cycle to ensure the amount they receive is timely and accurate. Achieving this deceptively simple goal is dependent upon insight – the ability to discern the true nature of a situation and to respond appropriately. Applying insight at critical points in the claims lifecycle can make a marked difference in reducing denials and accelerating payment.  The foundation of a successful claims management strategy begins with contract management, where advanced analytics and data-driven insight can help you quickly and easily pinpoint payment variances and validate reimbursement accuracy for each of your third-party payers. Ensuring compliance with contract terms allows you to identify recurring issues so they can be promptly addressed, while providing the ability to strategically evaluate overall contract performance. Once you achieve visibility of the contract process, you can apply those findings to other areas, such as claim scrubbing. Boosting the first-time pass through rate eliminates costly, time-consuming rework and speeds reimbursement. A strong claims scrubbing approach involves taking time, prior to submission to the appropriate payer or clearinghouse, to ensure the claim is complete, accurate and meets individual payer requirements. Once the claim is submitted, it’s not a matter of “out of sight, out of mind.” Tracking claim status early in the adjudication process – rather than waiting for a denial to appear on your desk – helps improve cash flow and maintain a healthy revenue cycle. An online payer portal provides instant insight into the status of each claim and gives you the ability to determine if a claim is lost, denied, pending or being returned. Regardless of how well you scrub claims before submission, it’s likely that a certain percentage will be denied. You can optimize and accelerate payments by quickly and efficiently identifying denied claims for analysis and re-submission. Use technology to ensure denied claims aren’t overlooked and streamline the workflow associated with claims management. Finally, taking a comprehensive look at all pending claims and denials allows you to prioritize claims and denials so that your staff can work the highest impact accounts first to improve efficiency and increase revenues.  Advanced technology that provides insight into contracts, payer requirements, claims status and denials holds the key to reducing the claims processing errors that add an estimated $1.5 billion in unnecessary administrative costs to the nation’s health system. Few healthcare organizations can afford to receive less than their fair reimbursement for the care they provide. By implementing a strategic approach that grants insight into each component of the process, healthcare organizations can bolster the bottom line and streamline efficiencies along the way. To learn more about how to turn these strategies into tangible results, register for our Dec. 3 Webinar, “5 Ways to Accelerate Your Claims Payments."