Tag: Coverage Discovery

It's time for healthcare providers to rethink patient access with patient-friendly digital solutions. Read the blog post to learn how.

Inflation is giving the cost of healthcare a run for its money. The Consumer Price Index rose by 8.3% year-over-year in August 2022, compared to a rise of just 2.9% in the Health Care Price Index. However, slower price increases do not necessarily mean healthcare will get an easier ride than other businesses. Healthcare contracts are agreed in advance with government and commercial payers, so any effects of inflation could simply be delayed. How should providers factor such economic unpredictability into their revenue cycle management strategies? Healthcare is usually more resistant to wider economic shocks than other service sectors, so rising inflation doesn’t necessarily mean there’s an urgent need to change course. Providers are always working to maintain a healthy revenue cycle and will continue to do so now. That said, the lingering financial effects of the pandemic, staffing shortages and increasing operational costs mean that provider cash flow is sensitive to any added pressure. While there’s currently no sign that patient collections have been significantly affected by inflation yet, patients may assume that health costs will increase too, along with everything else. This might lead them to delay elective care, which could affect providers’ bottom lines. As non-COVID patient traffic slowly returns and state and federal aid ends, rising inflation presents an additional hurdle to providers’ financial health. Providers will need to tighten their patient collections process and safeguard their bottom line. Download the white paper to learn how inflation is impacting healthcare and get strategies to optimize collections and avoid revenue loss. Providers that want to bolster their revenue cycle against the potential impact of inflation should focus on increasing workforce efficiency to manage costs and mitigate the risk of deferred care, to maintain a steady inward cash flow. They’ll also want to be prepared for any potential shift in patient payment reliability that could occur if inflation persists. Automated solutions and self-service digital tools can help to solve these issues. Minimize workforce inefficiency with automation and self-service solutions Questions to consider: How can digital technology and automation improve efficiency and ease pressure on staff? Where can patient self-service solutions help reduce the need for staff input? Inflation is likely to hit providers hardest in relation to payroll expenses. Staffing shortages lead to increased costs as providers raise salaries to attract and retain new staff, pay overtime costs, and hire more temporary workers. Reduced purchasing power will only exacerbate these challenges. Automation and digital tools can help address staffing shortages and keep a lid on payroll costs by increasing efficiency in existing workflows. For example, digital technology can allow patients to take care of many administrative tasks themselves, thus reducing the demand for staff input. Online self-scheduling and registration allow patients to book appointments and fill out pre-service paperwork without taking up valuable staff time. These tools leverage data and automation to pre-fill patient information, which reduces the risk of costly errors and saves time for patients and staff. Further along in the patient journey, automated collections can eliminate much of the manual work that puts pressure on understaffed teams, while increasing the likelihood and speed of payment. Collections Optimization Manager helps increase workforce productivity to make better use of staff time and avoid unnecessary revenue loss. Advanced analytics are used to prioritize accounts by payment probability, which will be increasingly useful should ongoing inflation increase the risk of patient bills going unpaid. Consumer data helps identify the most appropriate communications method for each segment, so the right message can be sent at the right time to boost the chances of collecting a greater percentage of money owed. Automation also helps reduce staff costs to collect, while bumping up the amount of money that comes in the door. As hospital operations become more expensive on the whole, maximizing efficiency in collections is increasingly important. Maximize revenue by removing friction for patients worried about the cost of care Questions to consider: How can providers help patients better understand their bills? How can digital technology make it easier for patients to access and pay for care? The second step is to make sure that dollars keep coming in the door. Managing household bills can be challenging for patients, and there’s no suggestion that the rise in inflation during 2021 has added any new pressure to patients’ ability to pay for healthcare. Experian Health’s clients also continue to see very low levels of delinquency. However, despite pay raises, many consumers are worried that price inflation will overtake any increase in household income, especially as energy and food prices go up. They may decide to cancel or postpone elective care until they’re sure of their financial situation or move their medical bills to the bottom of their priority list. In reality, costs for patients haven’t increased, because of the delayed effect of inflation in healthcare. That’s why it would make more sense for patients to seek elective care sooner rather than later. Given reports of pricing concerns, providers should consider ways to reassure patients about their financial obligations and make sure they don’t miss out on the care they need. Here are some ways that providers can support their patients: Providers can help patients get a better understanding of their medical bills and payment options, by incorporating solutions that offer greater price transparency. Upfront patient estimates delivered directly to their mobile device, with links to appropriate payment plans and payment methods, can help them plan with confidence. This will help to reassure patients that prices have not increased drastically due to inflation, so they are dissuaded from deferring care. Finding missing or forgotten insurance coverage is another strategy to give patients certainty around how their bills will be covered. A tool such as Coverage Discovery can run repeated and automated checks for previously unknown government and commercial coverage, using multiple data sources. Self-service patient access and patient payment tools can help to reduce friction during scheduling, registration and billing, so patients see fewer reasons to postpone care. Liz Serie, Senior Director of Product Management at Experian Health, says, “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” - Liz Serie, Senior Director of Product Management Find out more about how Experian Health’s digital tools and solutions can help healthcare organizations create a financial safety net and protect their revenue cycle against the possible impact of inflation.

Discover six ways providers can make healthcare payments easier and faster in 2022 with patient-centered payments solutions.

US hospitals have provided more than $702 billion in uncompensated care over the last two decades. Discover how to find missing insurance coverage.

In this infographic, we break down the changes to post-COVID-19 patient journey, and the changes that have impacted every step.

Learn about COVID-19’s impact on the patient journey and see how digital transformation is helping the healthcare industry recover.

Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. Shots may be free to patients, but someone has to pay for them – and getting reimbursed is proving to be a major pain. Complicated billing processes, extra billing audits and mountains of extra paperwork, rejected claims and slow payments are not exclusive to pharmacies helping vaccinate America. With the coronavirus pandemic continuing to muddy the insurance landscape, getting hold of missing dollars is challenging. Healthcare reimbursements haven’t been straightforward for other providers either: widespread coverage loss and uncompensated care is putting extra strain on hospital revenue cycles. With the coronavirus pandemic continuing to muddy the insurance landscape, getting hold of missing dollars is challenging. Providers must find ways to quickly and accurately determine each patient’s coverage status to minimize bad debt. Navigating the complex world of post-COVID healthcare coverage What does the reimbursement landscape look like, one year on? After a long wait, elective procedures are back. But the surge in patient volumes means providers must be on their toes to keep track of coverage. The process for doing so must be streamlined and precise. Ramping up capacity to verify and check coverage without burdensome paperwork is a must. Patient intake is under pressure. More patients are coming through the doors as a result of elective services and vaccination programs (though not always to their usual facility). COVID-19 hasn’t gone away, and with pockets of infection spikes, safety remains a top priority. Capturing adequate insurance information in this context is no mean feat. Running automated coverage checks as soon as the patient arrives will minimize face-to-face contact during admissions and avoid delays. Patient access and collections staff are overburdened. Manual checks are difficult when staff are operating remotely or in a socially distanced environment, and patient information might be incomplete. Automated self-pay scrubbing can help handle the volume. A tool with built-in reporting can also offer insights on workflow and productivity, to help spot opportunities for quicker claims processing. New digital healthcare technologies aren’t always covered by insurers. Telehealth, a life raft during COVID-19, tends to be covered less often by private insurers, compared to Medicare and Medicaid. Coverage checks must factor this in to avoid errors and wasted time. Providers should opt for tools that sweep for payer updates to telehealth coverage to avoid unnecessary delays or denials. Employment levels may be inching upwards again, but tracking coverage remains a challenge as patients start new jobs with new health plans. In addition, checking for Medicare coverage in the midst of changing codes and protocols is time consuming and confusing. A third-party resource such as Coverage Discovery can look for all coverage options and make sure the right bill goes to the right payer. Find missing dollars with Coverage Discovery Hospitals, pharmacists and other healthcare providers can’t afford to continue losing money at a time when every dollar is needed to prepare for “after COVID-19.” Experian Health’s Coverage Discovery is a proven system for tracking down missing coverage quickly and easily, to avoid unnecessary revenue loss. Using billions of data assets and intelligent confidence scoring, it combs through multiple government and commercial payer accounts to maximize actionable coverage. Staff can trust the outputs and focus their attention where it’s really needed. By making coverage identification more efficient and accurate, it’s a shot in the arm for providers in need of faster reimbursements. Contact us to see how Coverage Discovery can be easily integrated into your revenue cycle, so you can maximize reimbursements over the coming weeks and months.

Learn how Coverage Discovery optimizes insurance verification for COVID-19 vaccinations, ensuring faster reimbursements for providers.

If President Biden’s two trillion-dollar stimulus package is approved by Congress, support will include funding for a national vaccination program. While the arrival of the vaccine is an immense relief, the logistics for rolling it out across the country present a major challenge. Even at a rate of one million shots administered per day, it could still take 18 months to vaccinate 80% of the population. There are numerous supply, distribution and communication challenges to overcome, both at national and state levels. And for individual healthcare providers, mass vaccine administration calls for a holistic approach, to make sure the right patients get the right dose at the right time and place. Could data analytics and digital automation tools be the key to identifying, engaging and supporting patients as the vaccine program is rolled out? Here are 6 ways digital technology could help your organization improve vaccine management. 6 digital tools to include in your vaccine management plan Segment patient groups with consumer data Deciding who gets the vaccine first is only hurdle number one. Providers must then segment patient populations according to risk categories (such as age or occupation), so they know who should be at the top of the list. Without accurate consumer data, there’s a risk that some vulnerable patients will be missed out. The answer lies in data analytics. By synthesizing thousands of data points for more than 300 million Americans, ConsumerView gives providers the detailed insights needed to segment and target patient populations. At the tap of a button, providers can find out which patients are essential workers or in high-risk groups, so they can be channeled into the vaccine program without delay.  Improve patient access and engagement with data insights According to the Kaiser Family Foundation, six in ten older adults say they don’t know when and where to get the vaccine. Many patients also face access barriers such as lack of transportation or childcare, or poor digital literacy. If providers don’t account for these in their outreach and engagement efforts, their vaccine program will fall flat. Consumer data can again help providers understand who their patients are, to identify those who might have trouble getting the vaccine. Insights on the social determinants of health can point to the best communication channels and support services to offer.  Keep track of patient identities with secure patient portals If providers are reaching out to patients and encouraging them to schedule vaccine appointments through their patient portal, they must have confidence that the person signing up and logging in is who they say they are. The right security protocols can help validate and protect patient information. One example of identity proofing technology is Precise ID®, which uses knowledge-based authentication (questions only the real person would be able to answer) and device recognition to verify patient identities. Prompt patients to book a vaccine appointment with automated outreach Imagine if patients could receive a text or voice message notifying them that it’s time to schedule their vaccine, with a link and simple instructions on how to book. With automated outreach, providers can proactively text or call a segment of patients with self-scheduling options and specific messages about the vaccine and its safety. Not only will this help to increase vaccination rates, it’ll reduce call center volumes at a time when staff are already under pressure. Make it easy for patients to schedule appointments with online self-scheduling In order to meet daily goals for vaccine administration, it has to be easy for patients to book appointments. The last thing any provider wants is no-shows. By deploying scheduling software that ties vaccination qualification rules into the booking process, providers can match patients to a convenient slot, ensure they meet the correct segmentation criteria prior to booking, and confirm whether the appointment is for the first or second dose. And of course, an online self-service scheduling tool such as Patient Schedule allows this part of the patient journey to be completed with minimal face-to-face contact, minimizing risk of infection. Speed up reimbursement with automated coverage discovery Finally, providers must make sure that vaccine-related reimbursements run smoothly. CMS has ruled that every American should have access to the vaccine without incurring any out-of-pocket costs. But although the government may be footing the final bill, providers still need to seek reimbursement by payers, which means they still need a reliable way to check a patient’s coverage status. With Coverage Discovery, providers can run quick, comprehensive checks of commercial and government coverage, and identify the right payer for administrative services. Digital software and analytics can provide efficient, secure and convenient ways for providers to guide patients through the vaccine management process, without delay. Contact us for more information on how Experian Health can support your organization to deliver a vaccine management plan.