Tag: Coverage Discovery

Discover the reasons behind the rapid growth of data and analytics in the healthcare industry and explore their potential applications in the revenue cycle.

In today's healthcare landscape, providers face the challenge of making costs transparent and understandable for consumers. The Hospital Price Transparency Rule has driven progress in this area, but there is still work to be done. In 2022, 70% of hospitals complied with the Hospital Price Transparency Rule, up from 21% in 2021, according to the Centers for Medicare & Medicaid Services. The Rule mandates hospitals to provide consumer-friendly pricing displays for more than 300 shoppable services, plus a machine-readable file with rate information. To address this challenge, healthcare organizations need to leverage price transparency solutions that empower patients throughout their financial journey. By equipping patients with advanced knowledge of treatment costs and coverage details, providers can facilitate informed healthcare decisions, expedite payments, foster patient loyalty, and gain a competitive advantage. Prevent confusion about costs with transparent healthcare pricing A recent KFF survey found that almost six in ten insured healthcare consumers have encountered problems paying for care in the last year. More than half said they found it difficult to understand their health insurance, while three in ten said their insurance paid less than expected. Confusion about coverage can lead to delays, denials and difficulties in accessing care. Two scenarios are common when patients are faced with unexpected and increasing healthcare costs: 1) they delay care until their year-end deductibles are met, or 2) they forego care completely. Neither is good for their health, and both can disrupt providers' revenue cycles. By arming patients with advanced knowledge of treatment costs and how these will be split between patients and payers, providers can help patients make informed healthcare decisions without worrying about sticker shock. And price transparency is not just a question of compliance - making healthcare billing more transparent can be a driver for growth, through expedited payments, patient loyalty and market advantage. Compassionate financial counseling, flexible financing programs, clear billing statements and simple payment options all play a role. What can providers do to improve price transparency? Step 1 in delivering price transparency is to ensure compliance with the Hospital Price Transparency Rule. Experian Health and Cleverley + Associates have partnered to help providers satisfy the requirements. Experian Health's Patient Estimates supports providers in compiling the required list of shoppable service items, while Cleverley + Associates delivers the machine-readable files quickly and at scale. Jamie Cleverley, President of Cleverley + Associates, says: “Trying to pull together all of the required information in one place led to a lot of complexity for hospitals, at a time when a lot were short-staffed. We became a natural resource for hospitals. Since we have the information and the technical capacity, we could relieve the anxiety around compliance.” Riley Matthews, Lead Product Manager at Experian Health, says the joint approach has succeeded in helping hospitals comply with both aspects of the rule: “We had a portal that we can integrate with our clients' websites, where patients are able to walk through a user experience that guides them to their price estimates. Cleverley came in with the complex machine-readable files and has been a fantastic partner from the start… We're able to solve both sides of the price transparency rule and provide a holistic solution that delivers value for our clients.” Hear Riley Matthews and Jamie Cleverley discuss how this strategic partnership will help healthcare organizations address the challenges with compliance: Utilizing healthcare price transparency solutions throughout the patient journey To round out the patient financial experience, healthcare organizations should consider proactive solutions that promote clarity and convenience at every financial touchpoint. For example: Patient Financial Advisor is the first solution in the market to provide consumers with a pre-service, mobile-estimated patient responsibility and payment experience. This allows patients to make easy, secure payments as soon as they're ready. Patients get a clear breakdown of everything they need to know about their financial obligations, delivered straight to their mobile devices. To solve for confusion around coverage, Experian Health's Coverage Discovery® solution helps patients find missing or forgotten coverage. Patients welcome their providers' help in identifying additional coverage options, so they aren't billed for costs unnecessarily. Providers can seek reimbursement through those plans, rather than sending accounts to collections. Providers can also promote clarity when it comes to payments. PatientSimple offers patients a secure, 24/7 portal to view and manage their healthcare costs in a straightforward and convenient way. Not only can they see accurate price estimates at the touch of a button, but they can also apply for charity care, set up payment plans, update payer information and make payments to multiple providers. Implementing healthcare price transparency solutions to meet regulatory requirements Creating a more transparent approach to healthcare pricing and billing can be a daunting task in the context of ongoing regulatory change and operational challenges. It's time to incorporate Experian Health's innovative solutions to navigate ongoing regulatory changes, overcome operational challenges, and enhance the financial experience for both providers and patients. Find out more about how Experian Health is helping providers comply with price transparency rules and exceed patient expectations for clear and comprehensive billing experiences.

As healthcare providers strive to deliver the highest quality care, it’s critical to understand the importance of improving the patient experience. Patient experiences can have a huge influence on overall healthcare quality and long-term outcomes. This is good news for patients, who consistently say they value healthcare encounters that surpass expectations. Research by Experian Health and PYMNTS in 2022 uncovered frictions in the patient journey, with patients commonly frustrated by poor communications, confusing and time-consuming administrative processes, and a lack of digital choices. In 2023, patients sent a clear message in response to the State of Patient Access 2023 survey: more than half of those who think patient access falls short of expectations would consider switching providers for a better experience. Creating an outstanding patient experience built on empathy, choice and personalization is therefore key to retaining loyal and happy consumers. Healthcare providers should utilize digital tools to offer timely access to services, clear and comprehensive communications, and a tailored approach to patient engagement to foster patient satisfaction – or risk losing patients to their competitors. Why the patient experience matters The patient experience is a gateway to the healthcare system. It encompasses every step the patient takes while seeking and receiving medical care. This goes beyond the clinical aspects of care and includes all the systems and strategies that determine a patient’s access to care. From the moment they book their appointment through their clinical care and final bill payments, each interaction is an opportunity to make or break a patient’s satisfaction with their provider, so improving the patient experience is crucial. The connection between patient loyalty and a provider's revenue is undeniable. However, it is important to recognize that the patient experience plays a significant role in health outcomes. Inefficient systems can lead to missed appointments, while confusing billing practices can prompt patients to postpone care. Adherence to care plans is far more likely when patients are engaged in positive, streamlined and user-friendly pathways. And when patients are positive about their healthcare experience, there are trickle-down effects for staff too, as patient frustrations are minimized and efficient processes ease workload pressures. What does a quality patient experience look like? Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says that a high-quality patient experience should encompass three things: “Choice, flexibility and convenience are themes that have come through strongly in each of our patient surveys. Patients are more mobile and more digitally active, so they expect services to be available on demand. They have a diverse range of schedules, responsibilities and preferences, and providers need to accommodate these variations so accessing care feels easy and convenient. Providers that leverage digital technology to deliver a patient-centered experience will see higher levels of patient engagement, better health outcomes, and a healthier bottom line.” Key factors affecting patient experience Clinical care: It goes without saying that the quality of clinical interactions is a major determinant of the patient experience. Unfortunately, clinical staffing shortages are putting pressure on providers, particularly in rural and low-income areas and in specialties including primary care, obstetrics, and psychiatry. More than a third of nurses say they plan to leave their jobs. Automation and digitally enabled self-service technology could help make workloads more manageable, as well as improve patient outcomes and close gaps in care. Administrative processes: The convenience of booking appointments, registering for care, and navigating billing systems can greatly impact how patients perceive the quality of their care. Efficient and accessible online scheduling, simple and transparent billing, and a choice of channels through which to access information can all play a role. Staff friendliness and availability can also affect patient perceptions. Logistical factors: If patients can’t actually get to a healthcare location easily, this will have a negative impact on their experience. Opening hours, accessible facilities, cleanliness, parking and transportation are factors to consider. How to improve the patient experience (by opening the digital front door) For healthcare providers, there’s always a new delivery challenge around the corner. But it’s also easier than ever to improve the patient experience, thanks to digital technology. Online self-scheduling allows patients to book appointments 24/7 in a convenient and flexible way. Patients can see real-time appointment availability so they can see their doctor as soon as possible, and receive automated reminders so they don’t miss their appointment. Improving the management of cancellations and rescheduled appointments leads to more efficient use of doctors' time, leading to enhanced clinical experiences for patients, too. Targeted patient outreach solutions complement this, by helping providers schedule more visits with automated text messages and interactive voice response campaigns. Patients can book appointments and make payments right from personalized messages, instead of waiting for call centers to open or having to pay through slower traditional methods. Similarly, automated registration using patient intake software and patient portals allows patients to handle pre-appointment administration more easily. Recent data from Experian Health and PYMNTS found that a third of patients choose to fill out registration forms using digital methods, while almost two-thirds would change providers to one that offers a patient portal. In addition to delivering a consumer-oriented experience, automation relies on robust data, which reduces the risk of errors on patients’ records, in turn preventing delays and confusion. Finally, offering digital price transparency and payment tools is an essential strategy to meet patients’ expectations and help them figure out better ways to pay their bills. More than 6 in 10 patients who have received an unexpected bill or inaccurate estimate would switch providers, which again points to the competitive advantage in opening the digital front door. Proactive price estimates, support to find missing coverage, and tailored payment plans make the financial journey far less stressful for patients. Patient Financial Advisor can bring these elements together and give patients the option to make online payments, boosting patient collection rates. To enhance the patient experience, it is crucial to identify the moments when patients can be provided with support and reassurance. However, the impact of this goes far beyond patient satisfaction. By focusing on improving the patient experience, a chain reaction of advantageous outcomes occurs throughout the entire healthcare ecosystem, including improved revenue. Learn more about how Experian Health's digital solutions can help healthcare organizations focus on improving the patient experience.

Kate Ankumah, Principal Product Manager, shares how providers can navigate Medicaid redetermination and help patients explore new financial options.

“With Coverage Discovery, Luminis Health can now find more billable coverage, whether primary, secondary, Medicare or Medicaid. Luminis can follow up immediately with payers when there is no initial real-time eligibility response available. Not only does this improve financial performance, but it also reduces manual work and minimizes errors before claims are filed.” Sheldon Pink, Vice President of Revenue Cycle at Luminis Health Challenge Luminis Health is a not-for-profit health system with an annual revenue of $1.2 billion and over 9000 employees. As one of the top three hospitals in Maryland (according to the U. S. News and World Report), Luminis’ vision is to break down barriers to health and deliver more high-quality care across the region. Finding and verifying insurance coverage for more self-pay patients was contributing to Luminis Health’s levels of bad debt. Staff relied on manual processes that were time-consuming and inefficient, and a vendor solution that did not integrate with Epic®. Limited productivity led to delays, denials and compromised patient experiences. To resolve these challenges, the organization’s goals were to: Create a positive patient financial experience by providing accurate and quick patient financial estimates Reduce bad debt by finding accurate primary and secondary insurance coverage Eliminate manual processes for following up real-time eligibility (RTE) responses with payers Reduce the number of self-pay patient accounts that end up in bad debt Solution With Coverage Discovery, Luminis was able to maximize reimbursement, reduce bad debt and improve the patient experience. Coverage Discovery finds additional active coverage that patients may have forgotten about. Using verified patient information, proprietary databases and confidence scoring, the tool scans for active coverage across the entire patient journey. This means no financial stone is left unturned before the patient is billed directly. By identifying coverage that would otherwise have been missed, Luminis can avoid misclassifying patients as self-pay, and prevent accounts from being incorrectly sent to bad debt or charity. Staff can focus on accounts most likely to be rebillable to insurance, rather than wasting time on avoidable manual rework. In certain instances when patients do not know they have secondary coverage, Coverage Discovery: Verifies patient demographics to ensure patient details are correct Leverages a range of proprietary databases (including Employer Group mapping) and historical patient search information to find insurance that may have been used and verified at other locations Applies a confidence scoring system to reduce the noise and eliminate “false positives,” so the client doesn’t waste time reviewing incorrect information or irrelevant coverage Outcome As a result of using Coverage Discovery, Luminis found more than $240k in active coverage on average per month in 2021. They reduced the number of self-pay patient accounts ending up in bad debt and created positive patient financial experiences by minimizing patients’ financial obligations. Reducing reliance on manual processes also led to fewer real-time eligibility responses from payers. Sheldon Pink reports that implementation was straightforward, thanks to Coverage Discovery integrating seamlessly with Epic® and support from the Experian Health team: “We’re impressed with these results and with the partnership with Experian Health. Luminis is looking forward to building on this success and continuing to collaborate with the Experian Health team.” Find out more about how Coverage Discovery helps healthcare organizations find missing and forgotten coverage, to improve financial performance and contribute to a better patient experience.

Finding insurance coverage can be complicated, especially in an already complex reimbursement landscape. That's where Coverage Discovery can help. 

Discover 4 ways that healthcare providers can mitigate inflation’s impact on healthcare while reducing friction for patients and maintaining cash flow.

Learn how improving insurance eligibility verification at the early stages of the patient journey can help increase cash flow and reduce denials.

On April 1, 2023, millions of Medicaid recipients are set to lose coverage as the U.S. government’s COVID-19 public health emergency (PHE) expires. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Of this group, 6.8 million may be eligible to re-apply for Medicaid, but in the immediate term, it falls to patients and providers to sort through coverage questions, navigate charity and Medicaid eligibility, and keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, shares her insights on how Patient Financial Clearance and other digital solutions can help providers and patients cut through the confusion to achieve the best healthcare and financial outcomes during this time. Q1: The public health emergency is ending on April 1, which means that many will lose Medicaid coverage. How will this impact providers and patients? “Patients who qualified for Medicaid under the Public Health Emergency requirements during COVID will be dropped from Medicaid on April 1, leaving them without coverage,” explains Pankoke. “Healthcare organizations have been trying to reach out proactively to pre-enroll some of these patients, but others may not know what their options are or may show up to receive care without realizing they no longer have coverage.” Patients will face a range of financial challenges. “Self-pay patients may defer treatment, which could keep them from receiving the care they need and may ultimately lead to more costly hospital visits,” Pankoke says. “Also, patients may be confused about what’s happened to their coverage and what their options might be going forward. If they end up being responsible for paying out of pocket for care, some may have to choose between paying their medical bills and paying for food or utilities.” Providers will see a surge in patients needing help after losing Medicaid coverage With millions of patients in flux, providers will need to dedicate time and attention to helping patients sort through their concerns, including: Confirming whether Medicaid coverage is still in force Verifying coverage with new insurance Determining eligibility to re-enroll in Medicaid Qualifying patients for full or partial charity care Explaining patient financial responsibility and working out payment plans Managing billing and collections with a higher volume of accounts in AR Optimizing outcomes so that patients get the best care possible and providers end up with the least amount of bad debt Time is a critical element. Lengthy processes and administrative delays are likely to increase patient stress levels. Meanwhile, many providers face industry-wide staffing shortages. Time-consuming manual processes, multiplied by a sudden surge of affected patients, could quickly become overwhelming for staff. “For providers, this could be a hard situation to navigate,” says Pankoke. “At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offering them help can be powerful.” Q2: That raises an important question: How can providers create a compassionate experience for patients? “I think awareness is one place to start: making sure your staff knows this change is coming and that they understand the impact,” Pankoke says. “Your staff are the ones who’ll be working with patients personally when they come in and find out they no longer have Medicaid coverage.” But compassion doesn’t end there. “Many providers already have charity programs in place to provide relief for patients who can’t afford care,” says Pankoke. “The challenge lies in identifying the patients who need that charity assistance and connecting them to the help that’s available, while also learning which patients may still qualify for Medicaid and need help to re-enroll. Patient Financial Clearance uses credit and non-credit data to identify patients who may still be eligible for Medicaid, as well as self-pay patients who may qualify for charity assistance.” Using data-driven digital tools to quickly and proactively size up patient financial needs and offer personalized help can make the patient experience more humane. “Making these steps easier is another piece of being compassionate.” Q3: Screening for charity can be complicated, especially when new regulations are introduced – how do providers streamline this process? “My best advice is to embrace your charity programs and use a partner like Experian Health to help you automate the financial assistance screening process,” says Pankoke. “Patient Financial Clearance removes the manual screening for the likelihood to qualify for your charity programs and Medicaid.  It can automate the document-gathering in a patient-friendly way, and speed up the process to extend charity assistance, or work to enroll those likely to qualify for Medicaid early on before patients go through a costly uncollectable experience.” Automating these processes doesn’t have to be onerous. “Clients can provide their charity policy  requirements to Experian Health and let our expert consultants help to create the most effective and efficient workflows for Medicaid and charity screening both  up-front and as back-end scrubs.” Pankoke also urges providers to consider patient self-screening options as well: “Providers should consider other options aside from paper applications.  We’ve seen clients shrink the application process from 60 days of paperwork down to 3.5 days by enabling patient self-screening options via text.  This creates a better experience for the patient and hospital staff.” Q4: What else can providers do to help patients manage the cost of care? Providers can focus their resources on improving the patient's financial journey—for all patients, not just those who are struggling with their Medicaid status. Pankoke’s suggestions: Reach patients on their preferred channels - “Providers can empower patients with less paper-heavy ways to apply for financial assistance. Text and online applications embedded on your website or patient portal put the power into the patient’s hands using the channels they prefer.” Providers can also offer patients the ability to make payments right from their mobile devices using Patient Financial Advisor, making it easier to pay outstanding bills anytime and anywhere. Use data to gain insight into patient finances and offer personalized options - “In addition to screening for possible charity and Medicaid eligibility, Experian data enables providers to offer realistic payment plan options that consider how much the patient is likely to afford, enabling patients to bite off what they can chew with higher likelihoods of making payments successfully.” Customize collections - Sending patients who are struggling to collections may not be cost-effective or compassionate. “Providers don’t want to hound people for payment if the patient is having trouble covering their basic expenses and could qualify for Medicaid or charity care,” says Pankoke. Using Collections Optimization Manager, providers can tailor collections processes to their own specific needs. “A partner who is agnostic to your in-house and early-out agencies can help you manage, monitor, and optimize agency performance for maximum revenue.” Providers who are concerned about upcoming shifts to Medicaid coverage may want to consider leveraging solutions like Patient Financial Clearance, Collections Optimization Manager and Patient Financial Advisor to help them meet this challenge—along with the many challenges of managing patient financial needs in a rapidly-changing world.