Tag: contract management
Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage -- vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements? Contact us. Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage
Recovering underpayments from commercial insurers costs the healthcare industry billions every year. When payments come up short against what the provider expects, it’s not just the missing revenue that puts a dent in the bottom line – the staff time spent on reprocessing bills takes an extra bite out of the organization’s margins. Underpayments can be attributed to confusion around changing payer policies, inadequate claims data and simple human error. But when providers are focused on creating the best possible patient experience, keeping track of payer behavior is a task that’s easily crowded out. Unfortunately, failing to spot underpayments or keep tabs on those policy changes could lead to bigger revenue loss further down the line, in the time-suck that is collections recovery. From the payer’s perspective, it can be hard to understand why providers don’t just fill out claims according to the agreed rules. For providers, those rules seem to be in constant flux and different for each insurer. Ultimately, it’s a lack of communication that’s at the heart of the problem. Clean claims are only possible when payers tell providers exactly what they need, and providers have the systems in place to deliver that and check that payers are themselves following those rules. Within the industry, we already measure so many aspects of the revenue cycle, but are we paying enough attention to the payer-provider relationship? Is communication the missing metric? Three essential ingredients for a healthy payer-provider relationship Managing payer contracts can often be time consuming, complex and costly. Many healthcare providers are focusing on three strategies to help build better relationships with their payers, to take the stress out of this process and ensure they get reimbursed quickly and fully: Better communication. When you’re clear about what your payers need, you can make sure all your staff and systems are set up to deliver that. It’s impossible to fix the sticking points in your claims processing if you don’t know where they are. With a method to support better communication with payers, you can negotiate contracts that better suit both parties, keep track of changes to payer policies and move quickly when payers aren’t holding up their end of the bargain. You’ll know when a payer has made a payment at an out-of-network rate or reverted to rates in a previous policy and you’ll have the data your payer needs for a quicker recovery process. Two-way accountability. One way to build a better relationship with your payers is to hold each other accountable. Providers need to have systems in place to be able to hold payers to account for underpayments, but also to hold themselves to account for under billing. With a robust contract management tool, you can monitor payer compliance with contract terms and clarify what’s expected on your side to ensure you submit clean claims every time. Efficient processes: When the payer landscape is constantly changing, you need to have solid workflows to manage your claims processes as efficiently as possible. Automation and software solutions can help you minimize staff time spent manually checking payer policies, as well as generating the data you need to challenge underpayments. With a dashboard showing you real time claims data all in one place, your team will be able to identify, discuss and resolve queries with payers much more quickly than with disparate manual systems. How better payer monitoring saved one practice group $3.5 million in a single year In 2007, UCLA Health System Faculty Practice Group (UCLA FPG) saw $4 million go uncollected, largely down to difficulties tracking payer contracts. As the volume of payer contracts grew, it was harder to catch underpayments and manage the recovery process. Measha Ford, Director of Revenue Integrity at UCLA FPG says: “Before using Contract Manager, we didn’t have a method in place to track under and overpayments so there was a lot of lost revenue.” Without an efficient system in place, it was extremely challenging to manage collections data, monitor payer performance and spot when claims were being paid at out-of-network rates. This put UCLA FPG in a tough position to try to negotiate the best possible contracts with payers. By implementing an automated system, UCLA FPG could keep a closer check on payer contracts, eventually sustaining a recovery rate of 80% and recouping $3.5 million in one fiscal year. The data collected has not only helped to build a more predictable revenue cycle, but also supports more strategic decision-making when modeling new and amended contracts. And for Measha and her team, being armed with up to date, reliable data makes managing the relationships with payers so much easier, saving them time and effort that can be better used elsewhere. Find out more about how Experian Health Contract Manager can help you create friction-free interactions with your payers.
A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one. For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices. Keeping up with payer contracts In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex. The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG\'s numbers continued to fluctuate until implementing Epic alongside Experian Health\'s Contract Manager. Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster. Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.” The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials. Experian Health\'s team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA\'s contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes. Analyzing contracts before signing up In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It\'s also able to avoid unfavorable contract terms, as they are easily spotted through analysis. Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.
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.
In an ideal healthcare world, third-party payers would always make payments accurately and on time. Unfortunately, human error is unavoidable, so missed payments and underpayments happen. Identifying and correcting these inaccurate payments often falls to healthcare providers, and without a strategy to make sure payers are complying with your contract terms, these errors are bound to cause stress and volatility to your revenue cycle. There are, of course, external causes of underpayment that a provider can\'t necessarily control, such as payers misinterpreting contract terms or incorrectly calculating a payment. Providers, however, can counteract this by limiting internal mistakes like incorrect billing or failure to provide appropriate documentation. Still, it’s easy to let incorrect or late payments slip through the cracks, especially without a robust contract management system. Experian Health\'s Contract Manager and Contract Analysis tools can help providers make sure they\'re reimbursed quickly and accurately. How Contract Manager and Contract Analysis eliminate payment problems Experian Health\'s Contract Manager for Hospitals and Health Systems verifies the amounts owed for all applicable claims, monitors payer compliance, and models the financial implications of proposed contracts. And because Contract Manager’s data processing and storage is completely remote, providers get 24/7 web-based access with no capital investments required and no added cost for software or data updates. Contract Manager helped Timothy Daye, director of managed care contracting and reimbursement at Duke Private Diagnostic Clinic, part of the Duke University School of Medicine, identify underpayments and discover ways to avoid them in the future. “In addition to identifying underpayments,” Daye said, “there’s tremendous value in identifying billing issues that may result in underpayments and also identifying process improvements that can be implemented to eliminate the underpayments in the first place.” Contract Manager alone can identify and prevent late payments and underpayments, but when providers pair it with its companion solution, Experian Health\'s Contract Analysis, they can find added data and negotiating power to set contract terms that optimize third-party reimbursement. Because you don’t have a crystal ball to predict how all of the hundreds of variables in third-party contracts will affect payment, you need a contingency plan. That\'s where Contract Analysis comes in. By spotting unfavorable contract terms and offering real-world “what if” scenarios, Contract Analysis tells you exactly how proposed contracts with payers might affect your revenue cycle. You’ll know before signing on the dotted line how each part of the contract will play out. The Contract Manager and Contract Analysis combination allows you to audit payer contract performance to ensure compliance and maximize revenue. You could, for example, use it to check the accuracy of a reimbursement by comparing the expected payment to the actual payment, or you could recover from underpayments by finding lost revenue with data-driven insight. Contract Manager and Contract Analysis can also help you identify unusual causes of underpayments. For instance, when Daye and his team were working on a recent anesthesia project, they had to correct a non-standard billing situation. “The payer was taking a reduction by billing the QS modifier, which is outside of the norm of standard billing protocol,” Daye says. “We changed that process through the appeal with the payer by showing documentation that the QS modifier was informational only and doesn\'t warrant a reduction in payment.\" Had Daye and his team not been able to identify this system issue, they’d still be scrambling to determine why the payment was lower than they were expecting. However, by using Contract Manager and Contract Analysis, Daye was able to pinpoint an outside-the-norm situation and correct the payment discrepancy as quickly as possible. What makes the combo unique The Contract Manager and Contract Analysis combination is essential for any healthcare provider wanting to ensure it receives payments that are accurate and on time. By using proprietary valuation logic, these tools will give you more precise insight into your contracts, giving you a solid foundation to protect against any payment problems. Experian Health reimbursement specialists even offer complete contract maintenance to make things easier. Whether it\'s a coding typo or a misinterpreted contract item, there will always be some factor that could cause a payment error. And while you can’t control some of these unforeseen hiccups, you can use Experian Health\'s Contract Manager and Contract Analysis solutions to correct them in the most reliable, efficient way possible.
Not long ago, Excel spreadsheets were cutting-edge technology. Compared to stacks of paper and rows of filing cabinets, they seemed like an efficient, cost-effective way to organize and access data. But times have changed. Now, healthcare leaders are looking at their sea of spreadsheets wanting a simpler solution. According to KaufmanHall\'s \"2018 CFO Outlook\" report, 94 percent of the senior financial officers surveyed said that their healthcare organizations supplement their main data systems with spreadsheets. In the same report, more than half of them noted the need for better data visualization and easier report creation. This scenario could not be truer for Cody Torgler, physician revenue integrity coordinator with the University of Iowa Hospitals and Clinics. He realized that using spreadsheets was a waste of time and resources. \"It really took our follow-up staff away from what they do well,\" Torgler said. \"It was causing them to touch claims multiple times. Every time you touch a claim [that needs more attention], that\'s taking money away from a claim that you might be able to get reconciled.\" How did Torgler\'s team solve its spreadsheet struggles? They saved time, money, and headaches by implementing a contract management system that monitors payer compliance with contract terms, value claims, and audit remittances based on the latest payment rules and adjudication logic. The hospital\'s new system provides regular updates to staff on claims and offers visualization and more easily searchable data. Staff members can navigate their database by grouping attributes, filtering, or generating reports. \"The sky\'s really the limit with being able to find these variances, get these variances to the payer, and get them reconciled on time,\" Torgler said. The University of Iowa Hospitals and Clinics realized something other providers are coming around to as well: With better systems available, it\'s time to say sayonara to spreadsheets. Shake off spreadsheets and experience Experian For healthcare organizations that are ready to move past spredsheets, Experian Health offers a series of seamless data management solutions: 1. Claim Scrubber Spreadsheets get messy quickly. They\'re often maintained by multiple users, with different people entering data according to their own preferences. A less than immaculate spreadsheet might not seem like a big deal — until it comes time to fill out claims forms. That\'s when problems tend to snowball. Incomplete or inaccurate claims forms lead to undercharges and denials, wasting your team\'s time and effort. Experian Health\'s Claim Scrubber ensures every claim is clean. Even better, it\'s automated. Instead of wading through piles of spreadsheets, your staff can spend more time helping your healthcare customer. 2. Contract Manager and Contract Analysis Excel works in a pinch for records storage, but it\'s not great at keeping track of all the details of a patient\'s contract. Small fields with overflowing text can leave out important information and make it tougher for providers to see opportunities for negotiation. Experian Health\'s Contract Manager and Contract Analysis is like an automated contract lawyer. It helps healthcare organizations validate the accuracy of reimbursements, recover underpayments, negotiate better payment terms, and even evaluate potential lines of business. The bottom line? These tools leverage the best data to provide peak contract performance. Torgler\'s team at the University of Iowa Hospitals and Clinics uses the Contract Manager to stay on top of the hectic process of claims verification. \"With the claim count that we have at the university and the volume that we have, Contract Manager has made the transition from the Excel documents to check expected amounts seamless,\" Torgler said. \"The success of Contract Manager has allowed us to really grow at the university.\" 3. Patient Estimates Whether they\'re in for an annual checkup or open-heart surgery, patients like to know how much they\'re going to pay. But poor estimates are frustrating for everyone involved, and estimates based on a few rows of spreadsheet data are bound to be inaccurate. Only when patients are armed with the right estimates can they make informed decisions about what services they can afford. To provide accurate estimates, Experian Health\'s Patient Estimates tool relies on robust and continuously updated data. A spreadsheet might be able to hold information about a patient\'s claims history, contract terms, and insurance benefits, but why bother? Experian Health\'s tool gathers all that data automatically to issue top-notch estimates without unnecessary hassle. 4. Payer Alerts Once you close Excel, the information on a spreadsheet can\'t help you; it just sits there. Wouldn\'t it be nice to receive notifications whenever an insurance provider\'s payment policies or procedures change? That\'s why Experian Health\'s Payer Alerts keeps you current with an enormous range of payers. Information from more than 50,000 webpages run by more than 725 payers continuously feeds into the system, which then issues updates and distributes them via email and an online portal. With Payer Alerts, your organization will never be left out of the loop. The healthcare landscape is complicated and constantly changing. Spreadsheets just can\'t keep up any longer. Experian Health\'s data-driven solutions can ensure your organization doesn\'t get left behind. Schedule a demo with Experian Health today.
Uncertainty over the future direction of the U.S. healthcare system has left a high percentage of patients uninsured or underinsured. These patients rely more heavily on price estimates for care and self-payment options, and this places a heavy burden on healthcare organizations to collect patients\' payments more quickly. In addition, healthcare reimbursements are increasingly based on value. Now, providers can be penalized for giving patients inaccurate cost estimates about medical care. These estimates are taken seriously because inefficient and unpredictable revenue cycle management (RCM) that stems from errors, late payments, and other factors can cost healthcare providers up to 65 percent of their revenue. This raises a pressing question: How do you make a historically unpredictable revenue cycle less chaotic and more efficient? There are many factors to that answer, but most of them point to and lean on innovative, data-driven IT solutions, such as Experian Health’s suite of RCM tools. How can healthcare providers better predict revenue cycles? When revenue cycles are accurately predicted across the care continuum, patients can more easily pay the costs of their care, and healthcare providers can increase their collection rates. Coverages can also be identified that patients are unaware that they qualify for, helping them lower their out-of-pocket expenses and decrease healthcare providers\' risks of failing to collect payment. For predictability to matter, however, a revenue cycle needs transparency in pricing, particularly in the cost estimates patients receive before treatment. Precise, trustworthy estimates make it easier for Experian Health’s technology to generate clean claims that won’t be denied due to inaccuracies. Reducing claims denials not only allows healthcare providers to be paid faster, but it also saves the time, costs, and lost revenue of having to resubmit them. All of these factors can be challenging to address individually — and exponentially more demanding to do so all together. However, Experian Health’s goal is to relieve that weight by providing solutions designed to make predicting and managing revenue cycles a more efficient and profitable practice. How Experian Health’s solutions increase revenue cycle predictability. Boosting the ability to forecast a revenue cycle requires a variety of data-driven solutions. At Experian Health, our Eligibility, Coverage Discovery, Patient Estimates, and Claim Scrubber technologies are just a few of the many tools we provide to help. 1. Passport Eligibility Eligibility is a verification tool that combines up-to-date eligibility and benefits data for individual patients to ensure the accuracy of their upfront estimates. In turn, patients can rest easier knowing their predicted healthcare costs are accurate and derived from recent data.Additionally, the eligibility tool matches patients with Medicaid coverage that they were previously unaware they qualified for. Reclassifying patients and submitting their claims with the appropriate information lightens their stress about payments and increases a healthcare provider\'s chances of reimbursement. As a result, future revenue cycles become clearer. 2. Coverage Discovery Even patients with existing insurance may be unclear about what their coverage entails or how their plans apply to specific medical treatments. With our automated Coverage Discovery solution, hidden coverages are uncovered and applied to claims to avoid costly, time-consuming claim denials. The tool analyzes data from Medicare, Medicaid, and commercial insurance policies to help ensure patients don\'t pay more unnecessary costs. For instance, in 2016, Coverage Discovery uncovered a total of $1.8 billion in hidden coverages for more than 275 Experian Health clients. With a stronger understanding of what coverage applies to patients, healthcare providers will gain better forecasting knowledge of the pain points in patient pay, which increases revenue cycle predictability. 3. Patient Estimates With the information collected by the Eligibility and Coverage Discovery tools, our Patient Estimates platform can provide highly accurate cost estimates upfront. The solution utilizes data from numerous sources and populates that data automatically for each estimate to avoid human error. Patients who know what to expect about the costs of their treatment can make better, more informed decisions about their healthcare. They’re also more likely to pay bills they’ve carefully budgeted for instead of ones that are notably higher than the estimates they expected. By understanding this cost information in advance, both patients and healthcare providers reap benefits, making the revenue cycle run smoothly. 4. Claim Scrubber Next to garnished healthcare reimbursements, denied claims are another expensive consequence of an inaccurate revenue cycle forecast. Up to 20 percent of claims are denied or require reprocessing because of inaccurate or erroneous information. Our Claim Scrubber solution eliminates such errors by autopopulating claims with data pooled from a variety of relevant sources. Claim Scrubber reviews each prebilled claim line by line for inaccuracies and then applies extensive edits based on general, patient-specific, and payer-specific data. The digital scrubbing drastically reduces the time, lost revenue, and possible penalties associated with denied claims by boosting first-time acceptance rates. Overall, with the elimination of troublesome errors, this tool allows revenue cycles to be predicted with ease. In addition to providing an enhanced patient experience, successfully predicting and managing revenue cycles are both vital for healthcare organizations to thrive. At Experian Health, we believe that strong RCM is fundamental to any lucrative healthcare organization that strives to provide the highest quality of care. With our comprehensive suite of healthcare IT solutions, the current stress of RCM can soon become your organization’s best asset.
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.\"
