Tag: collections
Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.
Consumers are bearing a bigger burden of healthcare costs than ever before. As the third largest payer behind Medicare and Medicaid, many patients find themselves struggling to foot the bill, with implications for hospitals and health systems. According to a TripleTree report published late last year, consumer payments will reach $608 billion by 2019, thanks to growing enrollments in high deductible health plans (HDHP), decreasing payer reimbursements, and increasingly personalized insurance plans that come at a premium. Almost half of those under the age of 65 are enrolled in an HDHP. These rising out-of-pocket payments can cast a long shadow on the patient\'s experience. The payment process is often stressful and confusing, and many are unable to pay without careful budgeting or some form of financial support. And for providers, the growing admin costs of chasing payments can create a serious cash-flow problem. A forward-looking, patient-centered approach to billing is critical. A good starting point for providers who want to reduce friction around payments, optimize revenue and build a positive relationship with consumers is to look at how data and technology can improve customer payment processes. You can do this in three ways: transparent pricing, patient billing tailored to each individual\'s financial situation, and simplified admin processes all provide greater clarity and reassurance for patients. Make patient billing easier with transparent pricing New guidelines from the Centers for Medicare and Medicaid Services (CMS) call for hospitals to list chargemaster pricing on their websites, so consumers can make informed decisions about their treatment and plan accordingly. Unfortunately, the complexity of pricing structures and the way it\'s presented can still be very confusing for consumers. CMS Administrator Seema Verma tweeted that \"While the information hospitals are posting now isn’t patient-specific, we still believe it is an important first step & sets the stage for private third parties to develop tools & resources that are more meaningful & actionable.\" Patients are encouraged to tell the CMS if they can\'t find pricing info on their hospital\'s website, using the hashtag #WheresThePrice. However, there’s been a lot of criticism that the CMS requirements do not meet consumer expectations. Health leaders should aim to provide consumers with accurate personalized estimates, using data-driven technology. Most healthcare organizations already have the basic data they need to generate estimates for basic services, including: claims data real-time eligibility and benefits information payer contracts charge description master (CDM) information. Dan Wiens, Director for the Patient Estimate Suite at Experian Health, says: \"We\'re finding facilities are getting backlogged with calls while patients are trying to call in to speak to a live person to try to get an estimate... If a patient is comfortable understanding what they owe, they\'re going to be much more comfortable paying for their services.\" Giving patients accurate estimates upfront empowers them to understand their financial responsibility so they can make quicker, better decisions, and improve their overall experience. Saratoga Hospital used Experian Health’s Patient Estimates pricing transparency tool to eliminate the need for manually updating price lists and remove guesswork for patients and staff. By creating a standardized pricing and collection approach, the hospital was able to increase cash collections by 400% from 2015-2018. Personalize patient payment plans for a better patient experience The growth of consumerism in healthcare calls for a friendlier approach to the billing process, both for a better patient experience and to avoid non-payment. This means recognizing each patient as an individual with different needs and tailoring your offer at each stage of the revenue cycle. Some will be able to pay their whole bill up front, while others might need to spread it over a number of months, or seek support from a charity. Issuing the bill and hoping it gets paid isn\'t going to cut it – you\'ll be wasting time and money on repeated, unnecessary collection attempts. Instead, why not personalize each patient\'s payment plan based on their individual financial situation? No surprises for them, no missed payments for you. Insights from credit data can help you identify the best collection approach for each patient, so you can work with them to find financial assistance, set up payment plans in advance, or outsource payment to an appropriate co-payer. Simplify the admin process to improve patient collections These days, most of our life admin is done online, from banking to travel. Healthcare needs to do the same. You can make healthcare payments easier for your patients by giving them access to their accounts online, so they can manage it when it suits them. This is about making the revenue cycle as frictionless and consumer-friendly as possible. Data-driven technology makes it easy for patients to obtain accurate price estimates, set up or modify their payment plans, check their insurance details, combine payments to different providers, and facilitate mobile healthcare payments. Terry Manifesto, a Senior Director at El Camino Hospital, worked with Experian Health to allow patients to access and manage their data through a self-service portal: \"We\'re providing a lot more estimates than we could before, because it\'s 24/7, on the go - a patient can use it from their mobile device, from their laptop, or their desktop.\" With healthcare consumerism and outcomes-based care trending upwards, the dynamics of healthcare finance are shifting. A collections approach based on compassion and simplification is the key to building trust and optimizing revenue at the same time.
The burden of healthcare expenses on patients is a growing problem for hospitals and patients alike. Hospitals are losing about $7.5 billion in out-of-pocket medical expenses that go uncollected every year. And collecting patient balances has become more difficult largely because patients are struggling to keep up with rising medical costs. Insurance reforms that have produced higher copays, among other things, are putting a greater financial burden on patients. They are now expected to cover about 30 percent of medical treatment costs, but many cannot afford it. In fact, high medical expenses factor into two-thirds of bankruptcies. This means that as more patients struggle to pay for healthcare, the amount of bad debt hospitals have is rising. In a survey of 100 hospital executives, 36 percent reported that their systems had $10 million or more in bad debt. And their prospects for recovering that money are grim. The issue is that many healthcare networks don’t have the technology to handle their complex collections challenges. Martin Health System was seeking a solution to automate its collections processes for self-pay revenue. Based in Florida, the healthcare network has three hospitals and numerous outpatient clinics, as well as an emergency center. That translates to a lot of patient accounts to evaluate. Martin Health needed healthcare collection software. Optimizing healthcare collections Hospitals need to be able to analyze their records to determine which patients are most likely to pay. The right software makes that process more efficient and effective so healthcare organizations can improve their collections outcomes. Martin Health System had already optimized its registration and authorization phases but system leaders felt that it could further enhance collections efforts with an automated solution. In 2016, the network implemented Experian Health’s Collections Optimization Manager. The top priorities were segmentation, identifying charity cases, scrubbing for Medicaid opportunities, and better collection agency monitoring and management. The self-pay receivables management solution automates many aspects of healthcare collections using data analytics. Martin Health was able to optimize its collections efforts by determining how to allocate resources more appropriately and place accounts with the group best suited to collect for each account. To create a more compassionate experience, the software culls through patient data to screen accounts for bankruptcy, Medicaid and charity eligibility, patient expiration, and more, to remove the accounts that shouldn’t go to collections. Then it segments the data based on priority and treatment strategies and transfers those segments to the appropriate in-house collections department or agency. The software also continuously monitors accounts for changes in patients’ ability to pay, which is no small feature. According to the aforementioned survey of hospital executives, almost one-fifth of hospitals do not re-check patient eligibility for insurance. And even worse, one-fifth of hospitals lack any process or a third-party partner to recover bad debt. This one function alone could significantly improve hospitals’ collections efforts. Martin Health System accomplished its goal of better agency monitoring through an overview of collections progress that informed business decisions. Throughout its evaluation process, the Collections Optimization Manager provides performance reports in a real-time dashboard. And the service comes with support from revenue cycle consultants who review the data. They advised Martin Health on optimal collection strategies and suggested opportunities for improvement. Ultimately, Martin Health System enhanced its collection efforts while reducing the cost to collect. The healthcare organization also found new areas to increase collections performance. In just eight months, the healthcare organization transformed its collections performance. Having a better handle on its self-pay receivables boosted Martin Health’s overall receivables by more than $4 million in just six months. That included increasing collections by $3.1 million, and finding $975,000 in Medicaid coverage. It accomplished all of these goals by putting the right healthcare debt collection software in place. Read Martin Health’s success story here or schedule a demo to learn more.
Healthcare providers are relying on patients for more of their revenue as more of the burden of healthcare costs shifts to them. In fact, hospital revenue from patients’ direct payments increased by 88 percent between 2012 and 2017. At the same time, collection rates from patients who had balances over $5,000 were four times lower than those who owed less, according to a 2017 Crowe Horwath analysis. This creates problems for healthcare organizations working to keep its reimbursement rates up. This was the situation Advocate Aurora Healthcare found itself in when it decided to create a patient collections strategy. Its patient collections team was overwhelmed, attempting to manage 20 different collections agencies. The team realized that it needed to consolidate agencies, streamline patient collections, and improve the collections experience for patients from beginning to end. Reduce reliance on collections agencies through data insights To consolidate agencies, Advocate Aurora Healthcare needed a way to analyze each agency to determine the top performers, said Peter Troia, collections manager for the healthcare organization, which is comprised of more than two dozen hospitals. The organization also lacked workflows that reflected industry best practices, which hampered robust collections efforts. Employees couldn’t review the agencies\' performance (especially because it was all self-reported) and had limited access to data, few IT resources, and high internal collection costs. In-house collections could take an average of 139 days, and collections done by agencies were taking an average of 270 days. The patient collections team decided to implement data-driven technology that could automate the collections process and give it the opportunity to segment accounts and use propensity-to-pay models to help choose the right agency for the job. By determining patients\' ability and inclination to pay using data insights (including identifying potential charity accounts) and monitoring changes in their ability to pay, Advocate Aurora Healthcare is able to focus on placing the right accounts with the right resources to yield the best results. It has in-depth reporting and benchmarks to deliver actionable insights to optimize processes, forecast future performance, and improve financial outcomes. \"When we\'re analyzing our agencies, we can look at comparing their recovery rates on a month-to-month basis,\" Troia said. \"That gives me real-world business decisions that allow me to determine when do I place, how long do I place, what can I expect on a certain segmentation score, and how we can really impact different work standards to get the results we want to get.\" Advocate Aurora Healthcare was able to compare internal collections performance with the performance of outside agencies and went from working with 20 agencies to only the four agencies that had the best performance. Advocate Aurora Healthcare Results Leveraging business intelligence and analytics in patient collections helps Advocate Aurora Healthcare determine when to move accounts from accounts receivable to bad-debt status while giving its team insights into when an account should move from one agency to a secondary placement agency. It can prioritize inventory by segmenting and routing accounts and access performance reporting to put the healthcare organization in a good financial position moving forward. By automating the collections process, Advocate Aurora Healthcare has increased its collection dollars each year. Through the segmentation of accounts combined with outbound call campaigns, it has realized double-digit increases in patient collections every year. The more patients are paying out of pocket for their healthcare, the more healthcare organizations are going to need to work on their collections strategies. But it doesn\'t have to be overwhelming. With the right tools in place, your organization can turn things around and improve patient collections results. To read more about Advocate Aurora Healthcare’s success in patient collections, please download their success story.
As most doctors will say, healthcare is about helping patients, not making money. However, these two goals aren\'t as separate as some would assume. In order to help their patients, healthcare providers need to buy equipment, pay salaries, and spend money to maintain an effective, efficient customer experience. Revenue is what makes healthcare work, so preserving revenue should be a main priority for healthcare administrators. That\'s how Stacy Calvaruso, assistant vice president of patient services and revenue cycle at Louisiana Children\'s Medical Center (LCMC) Health, approaches her job. \"Revenue preservation is a term that we use in our organization to talk about how we\'re going to ensure that we\'re maintaining all the money that we can possibly collect for the services that we provide for our community,\" Calvaruso says. \"Everyone is being asked to do more with less, and patient access or the revenue cycle is no different than the clinical areas. We have to ensure that we\'re able to collect all the money and all the income that we generate as an organization so that we can put more money back into the community to provide more services to more patients.\" For help with revenue preservation, Calvaruso\'s team uses Experian Health\'s revenue cycle management tools. The full suite of Experian Health\'s revenue management products help LCMC Health facilitate patient access, manage contracts, process and submit claims, and streamline collections. Here\'s a closer look at how Experian Health approaches each stage of the revenue preservation process. Patient Access With 86 percent of leading medical practices seeing an increase in payer prior authorization, having accurate and comprehensive patient data is crucial to getting patients the treatment they need with fewer denials from insurers. Experian Health can help by verifying patient information at the point of service. From there, automated software coordinates patient data across all connected facilities so customers, doctors, and insurers are better informed about possible treatment options and how much they\'re likely to cost, eliminating any surprises in the payment or collections process. According to Calvaruso, a transparent process helps to prevent repeated work, which is a major cause of revenue loss. \"Instead of calling a patient after the fact about a denial or incorrect insurance information, we\'re able to call them on the front end to let them know that we\'ve verified their benefits, we know what the estimate of their out-of-pocket payment is going to be, we\'ve talked to their doctor, and we\'re ready for them to come and have these services,\" she says. Experian Health\'s Patient Access tools make it quick and easy to find the right information and avoid miscommunications and delays that affect revenue preservation. Hospital staff will be grateful for the lightened workflow and improved outcomes for both customers and administrators. Contract Management One of the most common clogs in revenue collection comes from unclear contract management. Without the right data to analyze contract compliance, hospitals will struggle to get accurate payments from insurers and customers. Calvaruso says that one of the cornerstones of her revenue preservation philosophy is reducing the avoidable denials; Experian Health\'s contract management tools can analyze and audit contracts to ensure payer compliance and clarify anything that could lead to such a denial. Experian Health\'s contract management tools also provide patients with more accurate estimates of treatment costs. One recent survey of 54 hospitals found that getting a price estimate is a frustrating process for patients; another poll found that 46 percent of younger patients aren\'t paying their full bill at the point of service because they didn\'t have an accurate cost estimate. Having accurate contract management data can make a big difference at both the point of service and in later payment collections. Experian Health\'s contract management tools can not only increase the revenue a hospital collects, but they can also improve the financial experience and build better relationships with customers and insurers. Claims Everybody makes mistakes, but given the amount of stress that healthcare providers are under, it\'s more likely that they\'ll make mistakes on routine paperwork like claims forms, which can lead to the kind of rework that hospitals loathe and that eats away at revenue. On top of that, without a streamlined system in place, it\'s often unclear where the initial problem occurred, which means administrators can\'t correct the problem for next time. \"We make sure we\'ve done all the work in the beginning to prevent the rework,\" Calvaruso says. \"One way we can do that is by using that lean process that assists us with identifying where we can improve.\" Experian Health\'s solutions helped Calvaruso develop that type of process. ClaimSource helps organizations prioritize the claims that need immediate attention, which saves time and reduces the number of tardy claim submissions. To avoid errors in the claims themselves, Experian Health\'s Claims Scrubber® makes sure clean claims are submitted the first time, eliminating the dreaded rework. Collections Submitting new claims after denials is aggravating, but bad debt write-offs are even more harmful to revenue preservation — it\'s money that the organization will never see, no matter how much more work is put in. The only way to ensure accurate collections is to minimize the risk of denial in the first place. As Calvaruso says, a key component of preserving revenue is moving back-office work to the front end. For collections, this means accurately verifying patient identity and analyzing litigation risks. Of course, not every situation can be accounted for, and there will always be issues with collections, Experian Health\'s collections solutions make it easier for organizations to prioritize their past-due accounts and pursue them effectively. No healthcare organization will ever receive 100 percent of the revenue it\'s due, but taking the right steps to preserve revenue can mitigate much of the loss and keep things running smoothly. With healthy revenue management, healthcare providers can better help the people who need them most.
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.
In 2014, Sanford Health set out to improve its success rate in collecting past-due patient bills. The health system increased its in-house collections by more than $40 million, and in a single year, it sent 28.5 percent fewer collections to outside agencies. How did Sanford Health do it? The patient account team improved its collections process with a hybrid approach of new tools and new ideas for patients and employees alike. Create a transparent system to identify the highest-yielding accounts Collections Optimization Manager allows the team to better manage patient collections by finding the patients who can and will pay. This is a big win. The team avoids wasting time and other resources on low-yield accounts. More importantly, when patients need Sanford Health’s financial assistance and charity services, they get the compassionate care they deserve. Previously, Sanford Health manually tracked and called patients who were late paying their bills. It was a cumbersome collections process, and the team had no way to focus its efforts on those people with the propensity to pay. The Collections Optimization Manager’s analytical models use precise algorithms to create segmented groups according to those patients who would prefer to pay in full at a discount, those who would prefer to pay on an installment plan, and those who are likely to be eligible for financial or charity assistance. Seamlessly integrate the new tool with existing ones The team coupled the new optimization manager with PatientDial, which they were already using and which routes calls to patient account representatives based on segmentation and decreases the cost of the collections process. Integrating with other products made it possible for Sanford Health to build upon previous success and easily implement the optimization manager with limited intervention from its IT department. Sanford Health was already using two other Experian Health products as well. First, Claim Scrubber helps Sanford Health submit clean claims to insurance companies and other payers, thus reducing undercharges and denials, optimizing staff time, and improving cash flow. Contract Manager and Contract Analysis audit payer compliance so the patient accounts team is assured that collections align with contract terms. Couple new tools with fresh, simple ideas Patient Statements is the final tool Sanford Health had already implemented when it embarked on its journey to improve the patient collections process. But it went a step further by redesigning the cover page. Now, patients can easily understand their payment options, including prompt-pay discounts. Also, the health system instituted an employee incentive program, which rewards staff members for their collections performance. Sanford Health is the largest nonprofit rural healthcare system in the nation. It has 45 hospitals and 289 clinics in nine states and four countries. It employs more than 28,000 people, including more than 1,300 physicians in more than 80 specialties. As Sanford Health grew and acquired new services, it realized that it couldn’t rely on a purely manual process to handle its collections process. Collections Optimization Manager turned out to be a profitable and otherwise satisfying collections solution. Collecting past-due bills is about money. And any business — even one focused on health and healing like Sanford Health is — must turn some of its attention to making money. But collections can be about more than that. It can be about making patients happier. It can be about figuring out who needs your help and exactly what kind of help they need. That’s what Sanford Health focused on, and it paid off. Learn more about how Sanford Health improved its process and collections success rate. Read the case study.
As deductibles and premiums increase, more patients struggle to pay healthcare bills, and, in turn, the patient collections process becomes more and more daunting. Hospitals and clinics are now relying on debt collection agencies more than ever. At Experian Health, we estimate a 119 percent increase in this specific outsourcing over a four-year period, from 2014 to 2018. A third-party debt collection agency is attractive for many reasons. For one, it frees up your healthcare practice’s valuable resources. Also, patients with delinquent bills typically respond well to a debt collector’s call. However, using a debt collection agency does not relieve all concerns because you must consider vicarious liability. By law, your hospital or clinic can be held responsible for the debt collection agency’s actions when it acts on your behalf. To keep your healthcare practice out of legal trouble and clear of costly fines, ensure the debt collection agencies that you hire comply with relevant laws and regulations. Also, consider using tools to make sense of these complex requirements. Do You Know the Laws Controlling Debt Collection? The legal requirements governing debt collection are varied and frequently evolving. It can take a lot of work to keep up with them, but there’s a tool to help you. We’ll describe this tool in just a moment, but first, let’s review a sample of federal debt collection laws and regulations to make sure you’re up-to-date: The Fair Debt Collection Practices Act (FDCPA) limits the behavior and actions of collectors who attempt to collect debts on behalf of another person or entity. This federal law aims to eliminate “abusive, deceptive, and unfair debt collection practices.” The Telephone Consumer Protection Act (TCPA) governs interactions between businesses and their customers, including healthcare providers and their patients. In many cases, this federal law requires consent before a provider can communicate with a patient’s mobile device through automated dialing systems, such as auto-texting or “robocall” systems. The Fair Credit Reporting Act (FCRA) regulates the collection, dissemination, and use of consumer information, including credit information. The Gramm-Leach-Bliley Act (GLBA) requires institutions to explain their information-sharing practices to customers and any available opt-out provisions. IRS Code 501(r) is a federal regulation enacted by the Affordable Care Act. It mandates certain financial assistance practices in order for an organization to maintain a nonprofit 501(c)(3) status. A key provision holds many hospitals and healthcare systems accountable for the acts of their debt collection agencies. The Electronic Fund Transfer Act (EFTA) establishes the rights and liabilities of consumers in electronic fund transfer activities, as well as the responsibilities of all parties. The Truth in Lending Act (TILA) requires disclosures about lending terms and the costs associated with borrowing.
