Tag: Patient Collections
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.
When was the last time you tried a new restaurant without reading at least one Yelp review beforehand? If you’re anything like the majority of American consumers, the answer is just about never. We live in an experience-driven world, after all, and whether you’re grabbing a bite to eat or trying out a new coffee shop, reviews are a great way to set expectations. But do patient reviews operate in the same way when it comes to hospitals? The answer is a resounding yes. Research shows that higher online ratings correlate with previously established metrics for evaluating hospitals, such as lower potentially preventable readmission rates. When it comes to overall satisfaction, patients are extremely perceptive, and they’re unafraid to share their opinions — good and bad. Yet Vanguard Communications found that about two-thirds of Yelp reviewers gave the top 20 hospitals rated by the U.S. News and World Report either a mediocre or poor rating. So where is the disconnect? One explanation might be that the areas assessed by U.S. News are too narrow. For instance, a hospital might rank highly for a certain specialty, bumping up its overall rating, but at the same time, its bill-pay system could be severely lacking, souring patients’ perception of the organization. Individual hospitals have the ability to assess all aspects of patient care — way beyond the scope of a top-20 list. The onus is on you to identify areas of improvement, and the best way to uncover hidden patient pain points is feedback. And those pain points are more than just the bedside care received, but are often related on the financial experience. Creating a better experience At Experian Health, we don\'t focus on tackling every issue in healthcare; one of our specialties is helping healthcare organizations process and collect payment. However, that specific aspect of healthcare has a significant impact on overall patient satisfaction. In a recent study, Experian Health found the highest amount of opportunity for improvement is around the patient financial experience, which includes things like price transparency, understanding one’s ability for health payments, as well as options to pay for care. When it\'s easier for patients to pay their bills, they rate hospitals higher. Unfortunately, the first big obstacle in bill-pay is that patients often don’t understand what they’re paying for. Even if the quality of care was excellent, when a patient is unsure how much he or she owes, it’s all too easy to get frustrated and give a poor review. El Camino Hospital, a nonprofit hospital located in Mountain View, California, saw this problem play out with its own patients and, in response, made price transparency a major priority. Experian Health teamed up with El Camino to address this pain point. We debuted a self-service portal, allowing patients to access and manage a greater amount of data while still making account management, e-payment, eligibility, estimates, and billing information available. The most exciting element of the portal for patients and administrators alike was the addition of the patient price estimator, which gives instant estimates on a wide variety of procedures. The response to this tool was so positive that patients immediately began using it, even before El Camino promoted it. There was still room for improvement, though, so we worked to gather more patient feedback by incorporating a feedback survey into the portal. As surveys and comments rolled in, we discovered that patients were looking for a wider variety of services in the price estimator, so we’re now expanding the options. This consistent, patient-centered approach has shown tremendous benefits already. For instance, because availability to the portal is on demand, patients no longer need to directly contact the hospital for estimates, which typically results in a 24-hour waiting period. Because the call volume has greatly reduced, El Camino is now able to provide far more estimates in far less time. While El Camino Hospital\'s portal implementation is still in its early phases, other hospitals have seen impressive results with similar systems over a longer period of time. At Cincinnati Children\'s Hospital Medical Center, for example, they worked with Experian Health to revamp their online patient portal to make it more attractive and easier for patients to use. After the launch of their revised portal, online payments increased from $200,000 to $800,000, and patient billing satisfaction dramatically increased, as enrollment in their billing portal jumped from 900 to more than 45,000 families in a single year. The medical center’s patients now use the portal to ask questions of their healthcare providers, change on-file insurance information, and schedule or revise appointments. These features also reduce customer service phone calls and other related costs. The 3 steps of the patient feedback process When hospitals empower patients with access to their individual data and listen to their feedback, everyone wins. Patient feedback is essential at every level of implementing a new service to guarantee maximum efficiency. A successful patient feedback process includes these three steps: 1. Identify where feedback is needed. You don\'t need to harass patients for feedback on every single aspect of their hospital experience. Instead, look at which services would most benefit from patient insight; then, deploy surveys in those areas. Gathering feedback on high-volume services should be a priority simply because they affect the highest number of patients. Similarly, services that routinely trip patients up can only be clarified by directly asking patients what’s causing problems. At El Camino Hospital, creating the charge description master (CDM) was the first step in identifying where feedback was necessary. The list provided a convenient overview, so hospital administrators could easily pick out which services were high-volume or problematic and address them immediately. Whatever the method, pinpointing the services that are particularly troublesome for patients proves much more effective than trying to elevate the entire experience with no direction. 2. Make it multichannel. Feedback is often subject to selection bias, meaning a customer is more likely to write a Yelp review when he or she is either extremely pleased or extremely angry. Offering people several options for providing feedback increases the chances that you\'ll get a good sample size. You can gather patient feedback via polls using various methods, including text message, email, phone, and paper mail. El Camino Hospital chose to add an SMS feature, building a feedback function on its desktop interface while continuing to field phone calls regarding more complex issues. Its choice proved rewarding, and patient feedback rolled in. Limiting your feedback channels limits the amount and type of feedback you receive, so the more options that are available to patients, the more likely they will be to share their opinions and suggestions. 3. Identify patients who need help and offer it. Patient feedback is only valuable if you act on it. Once you’ve identified specific problems, reach out and offer a solution to patients who expressed concerns. In conjunction with increasing transparency, El Camino Hospital set a goal to identify and assist at-risk patient accounts. After gathering feedback and information on these accounts, El Camino integrated a medical billing fundraiser to lend a helping hand. From there, it created alerts for other at-risk accounts to spread the impact of the fundraiser. By responding to feedback, hospitals can respond to concerns before they become more serious problems, as well as anticipate patients’. If one patient encounters a problem, it\'s likely that several more will encounter the same issue — if they haven’t already. If hospitals aren\'t listening to their patients, they’re missing valuable insight into their problems and limiting their scope of improvement.
Providers can improve the customer experience and bottom line with the power of data and analytics. Introduction In an increasingly competitive and consumer-driven healthcare marketplace, it’s no surprise that providers are working harder to acquire and retain customers. Higher out-of-pocket expenses combined with more choice and control in when and where consumers receive care are driving more retail-like shopping behavior. As a result, healthcare organizations are looking for ways to slow or stop customer churn, drive audience engagement, and redefine how they interact with their customers instead of seeing them through a clinical transactional lens. Providers understand that they must deliver a positive overall experience to maintain a favorable brand in the community and earn customer loyalty, key factors in maintaining their financial solvency. While there are many facets to consider in providing customers a great experience during their healthcare journey, there hasn’t been much attention paid to the intersection between the clinical and financial sides of this experience. According to findings from an Experian Health study among 1,000 consumers and select providers, the greatest pain points and opportunities for improvement around the complete customer healthcare journey center on the financial aspects, from shopping for health insurance to understanding medical bills. This means organizations that want to meet the new demands of consumerism in healthcare and improve the holistic customer experience must address the end-to-end revenue cycle. Typical consumer healthcare journey* *Consumers revealed 137 “jobs” or “needs” associated with their healthcare experience, with varied levels of importance, difficulty and satisfaction. Money matters give consumers high levels of discomfort Using a “jobs to be done” methodology, qualitative insights were gleaned as to the jobs, or microtasks and decisions, consumers associate with a healthcare journey. Despite the staggering number and complexity of different “jobs” consumers must undertake just to access the care they need, patients’ biggest dissatisfaction centers on the process of paying for their care. Of all the activities included in a consumer’s healthcare experience — from acquiring health insurance to making appointments with providers to receiving treatment — the top “pain points” relate to money matters. Specific issues for patients surveyed include: Understanding how much is owed for services and if the amount is a fair market price Making sure they have money available to pay for services Determining what financial support is available (e.g., a payment plan) Ensuring that what is owed to the provider is accurate Understanding the amount covered by their health insurance [click on image to enlarge] Providers also feeling the sting from unpaid collections, lack of customer service The most glaring opportunity for improvement in the patient experience comes early in the journey — price transparency. Patients are understandably confused about what their health insurance covers. They can’t always understand medical bills, and they have difficulty finding out how much their out-of-pocket charges will be and what payment options are available to them. Providers are also suffering — from unpaid collections, low customer satisfaction levels and an inability to address issues holistically. Here’s what providers had to say: We’re addressing the patient experience in one-off initiatives. Help us holistically improve the end-to-end patient journey. Providers said key impediments to progress include lack of clear and consistent prioritization, significant interoperability issues, and complicated organizational structures. They are frustrated by how hard it is to execute holistic changes efficiently. We need to measure our customer experience better. We want to standardize an approach that will drive progress and impactful change. Providers don’t have a clear path to move from customer experience as a concept to a measurable discipline. It’s a priority for them, but few are using a measurement system they feel is helping them understand and improve their patient experience. Patients are suffering, in part due to a lack of understanding of their charges. We want to set better expectations and make the charges and the value of our services easier to understand. Rising patient responsibility and the proliferation of high-deductible health plans drive the desire for full transparency in costs. Managing expectations at each step is crucial to providing the most accurate information to the patient. We’re not equipped to address customer acquisition and loyalty. Help us efficiently attract more consumers and keep them with us long-term. The focus has always been on healing people, with less attention to the business and marketing aspects of providing care. Providers need to focus efforts on acquisition and loyalty, but they’re generally understaffed and lack the skills to do so. There’s no doubt that healthcare organizations want to evolve and are thinking differently about how they deliver services and the value associated with those services. Ultimately, those that see driving customer engagement and redefining how they interact with their customers as a necessity, rather than a luxury, will succeed. Revenue cycle solutions for today’s consumerism environment Where to start? Key areas that can be addressed in the healthcare financial journey include: Comprehensive data – One of the core components of a patient-centric revenue cycle begins with the ability to use reference data to address duplicate medical records, understand a patient’s propensity to pay and identify social determinants of health. Incorporating this type of outside data into the revenue cycle won’t just create better patient experiences from the moment patients begin interfacing with staff, it will also optimize revenue for health systems while enabling a revenue cycle that puts the patient at the center of care. Patient identification – As hospitals must now deal with hundreds of thousands of electronic patient records, spanning multiple systems and departments, the traditional technologies for managing patient information are no longer sufficient. Using sophisticated matching technology and outside data sources can improve patient identification and prevent duplicate or overlapping records that result in inappropriate care, redundant tests and medical errors — as well as improving data accuracy for clinical, administrative and quality improvement decision purposes. Insurance reconciliation – Organizations can use automated technology to monitor claims data, real-time eligibility and benefits information, payer contracts, and charge description master (CDM) information to ensure that payers are meeting their obligations fully and achieve accuracy and transparency in healthcare costs. Closing the gap in payer contracts and reimbursement allows organizations to focus on providing transparent cost estimates throughout every patient’s continuum of care and helps patients know their costs so they are better prepared to pay them. Price estimates – Providing accurate patient estimates is quickly becoming the norm for health organizations. But to ensure patient satisfaction rates are being met, health organizations need to empower patients with a frictionless financial experience. By incorporating credit data into the patient billing process, health organizations can enable a people-first product design to price transparency and collections that extends benefits to more people by understanding the unique financial needs of each patient. Self-service portals – One way to engage patients is with an online and mobile-optimized experience that’s proactive, smooth and compassionate to empower patients to set up payment plans, apply for financial assistance, estimate the cost of care and review insurance benefits. Conclusion With so much to consider when addressing the evolving patient/customer journey, providers are well-served to start by improving their customers’ financial experience. As the link between customer satisfaction and a health organization’s revenue continues to grow, efforts to create a better financial experience are crucial. Using comprehensive data and analytics to power the revenue cycle and customer relationship management initiatives will allow health systems to encompass the end-to-end customer journey to ensure streamlined operations, measure and improve performance with payers, and provide accurate insights into each unique customer and their needs. The key to establishing this customer-centric mindset is embracing the power of data and analytics. From offering access to automated, personalized tools to providing price estimates to informing about charity aid options and offering payment plans — all these innovations help customers feel they can make better decisions about their care and how to pay for it. The result is more satisfied customers and an improved bottom line for providers.
As the health industry faces extraordinary changes, how can leaders better drive efficiency and optimize resources? Recently President for Experian Health, Jennifer Schulz, sat down with The Business Debate to answer this pressing question. In short, the best way to get there is to turn to data-driven technology. In this interview, Jennifer touches on some of the main barriers to efficiency in health systems: Patient financial payments and identity management. Here are some excerpts from her interview. To watch the video and read Jennifer’s editorial, please click here. Patient financial payments and price transparency “The use of technology in healthcare is slim. When a consumer in a retail experience or a financial service experience uses their mobile device, or goes online, that experience doesn\'t translate into healthcare. Experian Health is very focused on improving the transparency of healthcare from a financial perspective. We\'ve launched things like patient estimators because there’s no other large purchase you make in your life that you don\'t know what you\'re about to buy. And healthcare, for the most part, this all happens after the transaction, and that type of transparency in healthcare can come with the use of technology.” Universal patient identification “Another issue is identity isn\'t the same when you go from system to system. Every hospital, every provider looks at you as an individual, and puts a number associated with you. That number is within their system only, and so you may go across systems, but there is no view of identity. One of the solutions we\'ve launched here at Experian Health is the universal identity manager, and we\'re offering that with no charge to our clients because we think identity is the one key to provide transparency across systems.” As we have done for other industries, Experian is at the forefront of bringing this type of consumerism to healthcare. Through our data assets and technology, we empower our clients to connect with consumers through a tailored approach that is personalized along the patient journey. To learn more, visit www.ExperianHealth.com.
In a new whitepaper, Technology and Data-Driven Decisions Driving Best Practices for Patient Collections, Experian Health analyzes the results of two recently fielded surveys aimed at learning how organizations approach the process of obtaining payment from patients. The paper reviews both an HFMA-led survey and an Experian Health-facilitated one, discussing the current state of patient collections, as well as emerging best practices to improve performance. While knowing that organizations are working with varying degrees of success to offer more patient-friendly financial interactions, using technology and data to inform and drive patient engagement, Experian Health wanted to understand the best practices that organizations are using to elevate performance in patient collections. Our findings were published in this HFMA whitepaper which discuss the findings from these two research projects and validate best practices and offer unique insight into the successes and shortfalls of the patient financial experience at health organizations.
Manually cold-calling patients to remind them of upcoming appointments or of bills nearing a due date has never been an effective engagement strategy. On the contrary, such reactive tactics reduce engagement quality and can harm revenue cycles. It\'s important to remember that real connection empowers patients to be proactive in their care and improve their own outcomes, which encourages them to keep up with future appointments and medical payments. For modern healthcare organizations, maintaining this level of high engagement requires more than the automatic actions they’ve grown used to. Instead, the overall healthcare world needs more robust patient engagement to push forward and stay relevant with patients. Without this change, organizations are more likely to encounter skipped appointments, preventable readmissions, missed payments, revenue loss on several fronts, and poor patient outcomes. Fortunately, Experian Health offers a range of solutions that make it easy to engage patients in their care, improve patient outcomes, and create more profitable revenue cycle management (RCM) throughout an entire organization. Using patient engagement technology to improve care As previously mentioned in an Experian Health blog, patient portal technology — among others — is rewiring the technological landscape and capabilities in the physician and patient relationship. Portals are used for secure messaging by 41 percent of family practice physicians, and 35 percent of physicians also use them for patient education. This type of patient engagement technology culminates in our Patient Self-Service portal, which pools together data from our Patient Estimates, Patient Statements, and Coverage Discovery tools. The portal gives patients a single point of access to request estimates, pay bills, check financial assistance eligibility, and receive advice from doctors, nurses, and specialists. The above are just a few results from elevated, proactive patient engagement. Another perk is the portal’s unique ability to automatically populate patient-specific and payer-specific information into each estimate for optimal accuracy. This feature gives patients peace of mind by knowing what their exact out-of-pocket expenses amount to. When they receive a bill that matches the estimates they’ve been budgeting for, patients are more likely to adhere to payment obligations and return to a healthcare organization for future medical needs. This also makes it easier for an organization to collect payment at point of service and throughout the rest of the patient’s care continuum. Risk stratification for more successful revenue recovery For the first time in history, there is a growing convergence of powerful, internet-connected personal devices and massive amounts of analytical, social, financial, and behavioral data tied to individual patients. Experian Health’s timely patient engagement tools allow providers to tap into this convergence to revolutionize how they engage with patients at all points throughout their care. For example, by analyzing patient-specific financial information, this engagement technology can help providers identify when patients may benefit from financial assistance, especially for upcoming treatments. In turn, the provider can send the patient information about how to request for this type of assistance through an interactive portal with accurate estimates. To help reduce readmission rates for non-critical concerns, Experian Health’s tools can also help identify when patients may need unique, targeted engagement. For instance, patients with heart conditions can benefit from information regarding diet and lifestyle changes that improve cardiovascular health. These tools help providers determine the best type of content to send and the appropriate medium to send it through, such as email, text, or app notifications, according to the patient’s specific preferences. By working together with healthcare providers, Experian Health’s solutions combine highly personalized self-service with accurate price transparency and patient-risk stratification to proactively engage with patients. You, too, can be at the forefront of improving patient outcomes and RCM strategy effectiveness by understanding the changing healthcare environment. Utilizing tools, such as a patient portal and others, can position your organization to increase patient engagement and benefit from being a forward-facing healthcare provider.
Consumers love the ability to research and compare prices of products on the fly so they know upfront what they’re signing up for. They’ve come to expect this level of empowerment in every transaction. Yet in healthcare, that expectation is now a demand as patients shoulder increasingly higher out-of-pocket costs. Patients are also wary of being surprised by exorbitant hospital bills months after care. As a precaution, they want to know how much of the costs they’ll be responsible for before they receive treatment. Additionally, it would also be nice to make payments and schedule appointments online without being put on hold for hours or dealing with confusing call centers. Until now, healthcare providers have been more or less behind the times when it comes to integrating technology into everyday workflows. With this in mind, organizations need to make price transparency and self-service vital aspects of the care they provide, and they need the right technology to do it. Fortunately, benefits of self-service portals not only include price transparency, but also appointment scheduling. Experian Health’s range of tools, such as the Patient Self-Service portal, makes it easy for any healthcare provider to catch up and equip patients with the tools they need to be confident in their care and payments. Advantages of self-service portals Patient engagement is the cornerstone of quality care and clinical outcomes. However, it can be difficult when patients are prematurely frustrated because they already know they’ll be hit with higher than expected costs for their visit, tests, and treatments. As a solution, moving patient billing to the front of the revenue cycle eliminates that worry, making it the first step to build trust and improve patient engagement. The next step is making administration simple and convenient for patients. Scheduling appointments, changing insurance or address information, and asking questions about their treatment shouldn’t be arduous processes. When patients can accomplish these tasks quickly and conveniently, they feel more satisfied with their chosen healthcare provider. Empowering patients through information and engagement helps them manage their ailments, illnesses, or simple doctor visits more efficiently, which translates to fewer readmissions. Providers can also improve their cash flow by delivering accurate estimates and immediate balance notifications, rather than making patients wait up to 30 days for paper statements. In turn, patients and providers can both benefit from using a self-service portal because it improves virtually every aspect of healthcare administration. Key benefits of self-service technology in an all-in-one portal Experian Health’s Patient Self-Service portal makes it easier to keep patients informed and empowered, which not only improves the quality of their care, but also aids an organization’s financial health. For instance, manual scheduling alone takes one person or a team of full-time employees, which can be costly. On the other hand, in a self-service portal, patients interact directly with technology without the need for full-time human assistance. The easy-to-use portal isn’t just about scheduling, though. Through the portal, patients can also check whether they qualify for financial assistance, receive support for presurgery planning and postsurgical follow-ups, and email questions to their medical team. Another helpful portal feature notifies patients about their possible qualification for charity care. If eligible, patients can avoid medical bankruptcy by setting up a crowdfunding page to help pay their bills. Furthermore, the portal is accessible 24 hours a day, seven days a week. It\'s where the head of a household can review and update the entire family’s billing, account, and insurance information conveniently in one place. In addition, patients can receive a consolidated bill that\'s easy to understand and set up automatic payments so they know how to budget for future healthcare costs. Combined with upfront price transparency – which is now a legal requirement in many states – the Patient Self-Service portal provides vital benefits for streamlining healthcare administration and engaging with patients on the level that they need and expect.
Almost every day, new developments come from Washington, D.C. regarding the U.S. healthcare system. From the Affordable Care Act and Medicaid expansion to laws and regulations governing cost transparency and debt collection — there\'s constant fluctuation. This affects healthcare organizations across the country. They don’t know what rules they’ll be operating under in the future, but they do know they’ll have to meet these changing laws and regulations to avoid fines or lost revenue. Consequently, a crucial question emerges: How do you comply without overburdening employees? Compliance with laws and regulations: 3 ways Experian Health can help The answer is in technology. Healthcare organizations need systematic changes and IT solutions that help establish stability and security. For example, Experian Health’s data-driven technologies help organizations remain compliant with laws and regulations while improving the population\'s health and ensuring more successful collections. Here are three ways Experian Health can help: 1. Early and accurate cost transparency Nearly 30 states have current laws and regulations that require and govern healthcare price transparency. This list will continue to grow, so organizations need to thoughtfully prepare. Even if it weren’t legally required, patients are now demanding more transparency as they bear more healthcare costs. Historically, the problem stems from patients not receiving accurate, upfront cost estimates. They’re surprised and dismayed when medical bills arrive weeks or months after treatment. If patients are unable to successfully budget for these high costs, then collecting payment becomes more difficult. Experian Health’s Patient Estimates solution solves this by producing fast, highly accurate estimates based on a variety of data. Employees don’t need to manually update price lists, which eliminates the guesswork that leads to outdated, inaccurate estimates. Patients can even self-request treatment estimates through a self-service portal or mobile app. When patients know what to expect before they receive treatment, they’re more willing and able to adhere to payment plans. With our Power Reporting feature, organizations can also accurately judge potential and actual revenue recovery to vastly increase the rate of successful upfront collections. 2. Ensured compliance of third-party vendors Accurate and upfront estimates make capturing revenue easier, but they don\'t eliminate the need for collections. With patients paying higher percentages of medical costs, healthcare organizations now rely more on agencies to collect debt on their behalf. However, if an agency doesn’t comply with all healthcare laws and regulations that govern debt collections, then it could be liable for its practices. The Fair Debt Collection Practices Act (FDCPA), the Telephone Consumer Protection Act (TCPA), and the Truth in Lending Act (TILA) are examples of these regulations. In addition to maintaining overall compliance in your organization, being responsible for a collection agency working on your behalf can be burdensome. This burden increases when a large percentage of your patients live out of state, making them harder to manage. 3. EMV-optimized payment solutions With more payments coming directly from patients, the risk of credit card fraud is exponentially higher. Healthcare organizations can be held liable for any fraud that occurs on their watch if they haven’t upgraded their systems to be compliant for EMV payments. To help avoid credit card fraud or liability, we offer state-of-the-art card acceptance devices. These are powered by our PaymentSafe technology to provide a patient payment solution that is highly secure and EMV-ready. Because PaymentSafe is processor agnostic, it can be integrated with Experian Health’s eCare NEXT suite of products to leverage the data created at other points in the revenue cycle. It also works in a standalone environment and can be used at a kiosk, through a patient portal, or on a mobile app to accept all forms of tender. PaymentSafe and other Experian Health solutions make up an advanced, integrated revenue cycle that consumes and displays information from a wide variety of sources. The goal is to increase collection opportunities and cash flow, lower the costs of collections, allow staff members to use their time more efficiently, and increase patient satisfaction. It also makes it easier to adapt to compliance regulations that can only be met with the help of advanced technology. The country\'s healthcare laws and regulations may be in flux, but Experian Health continues to help hospitals and medical groups keep up with safe and secure solutions. By providing increased price transparency, better oversight over debt collectors, and highly secure payment solutions, Experian Health’s suite of products can make navigating complex compliance laws and regulations a breeze. For more information about current laws and regulations in the healthcare industry, please visit: S. Department of Health & Human Services — Laws and Regulations overview Health Insurance Portability and Accountability Act (HIPAA)
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.
