Tag: Patient Collections
For healthcare providers, revenue cycle management has become more important than ever. Due to increasing complexity in the payer mix and patients encountering more out-of-pocket costs, revenue cycle directors are also finding management an uphill battle. To maximize their reimbursement rates, today’s healthcare providers must take control of revenue cycles, and that requires optimizing three particular areas: estimates, claims, and collections. However, this task is much bigger than one person or department to enforce. For success, revenue cycle directors require an array of reliable, automated solutions that allow leveraging a wide range of data and comprehensive analytics with minimal employee input. At Experian Health, we offer a variety of solutions that help optimize healthcare systems\' revenue cycle management by simplifying the three key areas mentioned above. Unlock vital revenue cycle management capabilities With patients taking more responsibility for their medical costs, modern revenue cycles are most successful when tailored to patients. This includes providing accurate cost estimates upfront, making sure claims are clean before submitting, and prioritizing debt collection efforts where they are most successful. 1. Patient Estimates: providing accurate estimates early In our consumer-centric environment, patients expect a greater level of insight into the costs of medical procedures, preferably before receiving treatment. No one likes to be surprised months after treatment with medical bills that far exceed what they expected. In addition, state laws now require hospitals to provide more accurate patient estimates. For consistently accurate cost estimates, a healthcare provider must have a dependable price-generation process. For example, the estimates should incorporate a patient’s specific insurance information for accuracy. They should also be compared to the patient’s propensity to pay so a payment plan can immediately be set up, much like how financial institutions treat automobile loans. Patient Estimates, Experian’s price transparency tool, auto-populates much of the necessary data so healthcare providers can deliver accurate patient estimates as early as possible. In turn, consistently accurate cost estimates raise healthcare providers\' chances of collecting revenue upfront and help avoid unnecessary headaches during the claims and collections processes. 2. Claim Scrubber: submitting clean claims The conflicts caused by denied claims are expensive to fix. Interactions with payers cost medical groups thousands of dollars per physician each year. Many of those interactions result directly from denied claims, which often stem from inaccurate data. Claims data can be edited in Experian Health\'s Claim Scrubber, which reviews each claim line by line and makes edits based on the platform\'s data. Claim Scrubber combines the data with general, payer, and patient-specific information to guarantee each claim is properly coded every time. 3. Collections Optimization Manager: collecting debt strategically and efficiently If a healthcare provider wants to redesign its collection processes to center around patients, it should rely less on random outbound calls and focus more on insight regarding each patient’s propensity to pay. The burden of collecting on past-due balances is a demanding task. It also reduces a healthcare provider\'s chances of successfully collecting bad debt. One of the most important reasons — among many — to consistently provide accurate estimates and claims is to make collecting debt more successful and less time-consuming. Granted, a healthcare provider can\'t expect to collect every single outstanding fee. However, by concentrating on patients who are able to pay, a much greater percentage can be collected. Furthermore, Experian Health\'s Collections Optimization Manager helps complete revenue cycle management by using in-depth collected data to identify patients who are most likely to pay their hospital bills. In turn, staff members can utilize their time and resources more efficiently by contacting these specific patients first. Like most companies, healthcare providers are beginning to realize that patient engagement is a top priority. With this elevated engagement comes the need for consistent price transparency for medical care. Luckily, Experian’s automated engagement solutions can help your healthcare system provide the increased transparency it needs while also optimizing its revenue cycle management.
With the ability to research products, compare price information, and conduct transactions all from their mobile devices, today\'s consumers are more savvy than ever. They expect an unprecedented level of transparency from companies. In fact, they demand it and will easily take their money elsewhere if a company doesn\'t follow through. Consumers expect the same high-level transparency from healthcare providers, and the demand is growing as patients are forced to bear more out-of-pocket costs for medical care. They want to avoid surprises, such as higher-than-expected cost estimates for services or insurance that may cover only a small portion of the expense. Price transparency initiatives are becoming increasingly more important in healthcare systems, and providers must embrace new capabilities to meet patients\' expectations. The old model of billing patients weeks or months after they’ve received services is no longer viable. Billing needs to move to the front of the revenue cycle management process, and a number of Experian Health\'s solutions are designed to help do just that. 3 tools for greater price transparency in healthcare As patients are responsible for a higher percentage of their healthcare costs, healthcare providers\' financial performance depends on an optimal collections strategy that focuses on patient engagement. The advantage of patients knowing and having confidence in healthcare cost estimates makes the collections process much easier and helps drive the future revenue cycle. Here are three Experian Health solutions that can help healthcare providers improve price transparency: 1. Patient Estimates: Patient trust is built on meeting expectations. With this in mind, Experian Health\'s Patient Estimates tool brings accurate, upfront price transparency before or at the point of service so patients know what to expect and can confidently make decisions about their healthcare. Cost estimates are derived from numerous types of data, including a patient’s benefits information, a healthcare provider\'s reimbursement agreements, and payer contract rates, among others. Much of the information can be automatically populated into the system, eliminating the need to constantly update price information lists and reducing the risks of inaccurate cost estimates resulting from error. With Patient Estimates, healthcare providers can also more effectively comply with state and federal price transparency requirements. 2. Patient Statements:Accurate price information is one thing, but even if the patient’s billing statement matches the cost estimates, collections can be a challenge if the statement is hard to read or understand. Patient Statements is a communications tool that simplifies and customizes patient billing statements, complete with important, easy-to-understand updates and messages. Making billing statements straightforward for patients to manage helps healthcare providers build a stronger level of trust when it comes to payments. Personalizing the statements with marketing and educational information turns them into valuable resources that create a better overall patient engagement experience. 3. Patient Self-Service:With accurate, upfront price estimates and simple, useful bill-paying systems and statements, healthcare providers can more successfully integrate our online self-service portal. Experian Health\'s Patient Self-Service tool digitally delivers cost estimates and statements to patients. It also allows patients to securely make payments and conveniently schedule future appointments from their desktop or mobile devices. Patient Self-Service brings the high level of price transparency to healthcare providers that consumers now expect. This makes it more likely for patients to meet their self-pay responsibilities and return for future healthcare services. Patient Self-Service also helps healthcare providers more efficiently comply with \"meaningful use\" Stage 2 program requirements. The capabilities for price transparency that these solutions provide is just a small sampling of what we offer today, and we’re continuing to research and develop even more useful tools. In addition, we’ve recently launched an extensive consumer research project to better understand patients’ wants and needs. We’re excited to use these insights to continue developing solutions that help healthcare providers improve engagement with patients.
Cincinnati Children’s Hospital Medical Center (CCHMC) is a distinguished nonprofit academic medical center and one of the oldest pediatric hospitals in the United States. A few years ago, the center set out to make a much-needed change: upgrade its online bill pay system, as the current system was not popular with patients. The center kept two important objectives in mind while implementing the reboot: offering patients an attractive online experience and making it easier for patients to understand what payments they owe. Attracting patients with an intuitive bill pay system In 2012, CCHMC launched Patient Self-Service to deliver a more intuitive, comprehensive online portal. Before the launch, 900 families used the medical center’s basic online bill pay system. But after a small marketing push to promote the new option — a simple note on the center’s paper statements describing Patient Self-Service — enrollment jumped from 900 to more than 45,000 families in a single year. Plus, CCHMC saw immediate cost savings and increased revenue: The cost of distributing general notices dropped to $0. This was a significant change because mailing a notice about a new customer service phone number in the past could cost $1,400. Online payments increased from $200,000 to $800,000 per month. 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 reduce customer service phone calls and other related costs. In addition, the new bill pay system makes it easier for patients to clearly see and complete payments. Patients can request a cost estimate before treatment, submit payments, and set up payment plans — all online and whenever it is most convenient for them. Helping patients understand the bills they pay When CCHMC released its new self-service portal, the center also used Patient Statements to simplify and customize hard-copy bills. In the first year after the launch, the medical center saved $70,000 in invoicing costs for three reasons. First, the medical center reduced printing and mailing costs by utilizing a more attractive, interactive online bill pay system. Second, it minimized material costs by trimming invoices to a one-page statement. Lastly, the center saved on postage rates by earning the five-digit ZIP code discount. Institutions can earn a discount by bundling statements directed to the same ZIP code, thus reducing time in a postal processing center. CCHMC also combines hospital and doctor bills in a single statement that explains all treatment costs. The medical center can also add personalized messages related to each patient’s interests to foster engagement through educational opportunities, videos, microsites, and social media. Two of the most important ways a company communicates with its customers are through billing and customer service. For example, a bill pay system can give many impressions: that a company cares about its customers, doesn’t care, or, worst of all, attempts to trick its customers. It’s common to read stories about the hidden fees lurking in airline or cellphone bills. In fact, entire marketing campaigns are built around the idea — think of those “no hidden fees” commercials. Unfortunately, such instances also occur in the medical industry, which is why it is crucial to be upfront and transparent with patients. For a medical center like CCHMC, billing and customer service may rarely be in the same important spotlight as patient interactions with doctors and nurses. Still, no medical center wants to detract from its reputation by providing any kind of faulty service. CCHMC proves it cares about its patients every day by giving them an intuitive, comprehensive self-service portal and improved statements that just make sense. In the end, the hospital saved money and boosted revenue with its improvements, but it ultimately achieved much more in the overall care for its patients. To learn more about CCHMC use of Patient Self-Service to improve its bill pay system, read this case study. To see how Experian Health helps improve ROI in healthcare, view the full list of our client videos and case studies.
In 2014, Sanford Health set out to improve its success rate in collecting past-due patient bills. The health system increased its in-house collections by more than $40 million, and in a single year, it sent 28.5 percent fewer collections to outside agencies. How did Sanford Health do it? The patient account team improved its collections process with a hybrid approach of new tools and new ideas for patients and employees alike. Create a transparent system to identify the highest-yielding accounts Collections Optimization Manager allows the team to better manage patient collections by finding the patients who can and will pay. This is a big win. The team avoids wasting time and other resources on low-yield accounts. More importantly, when patients need Sanford Health’s financial assistance and charity services, they get the compassionate care they deserve. Previously, Sanford Health manually tracked and called patients who were late paying their bills. It was a cumbersome collections process, and the team had no way to focus its efforts on those people with the propensity to pay. The Collections Optimization Manager’s analytical models use precise algorithms to create segmented groups according to those patients who would prefer to pay in full at a discount, those who would prefer to pay on an installment plan, and those who are likely to be eligible for financial or charity assistance. Seamlessly integrate the new tool with existing ones The team coupled the new optimization manager with PatientDial, which they were already using and which routes calls to patient account representatives based on segmentation and decreases the cost of the collections process. Integrating with other products made it possible for Sanford Health to build upon previous success and easily implement the optimization manager with limited intervention from its IT department. Sanford Health was already using two other Experian Health products as well. First, Claim Scrubber helps Sanford Health submit clean claims to insurance companies and other payers, thus reducing undercharges and denials, optimizing staff time, and improving cash flow. Contract Manager and Contract Analysis audit payer compliance so the patient accounts team is assured that collections align with contract terms. Couple new tools with fresh, simple ideas Patient Statements is the final tool Sanford Health had already implemented when it embarked on its journey to improve the patient collections process. But it went a step further by redesigning the cover page. Now, patients can easily understand their payment options, including prompt-pay discounts. Also, the health system instituted an employee incentive program, which rewards staff members for their collections performance. Sanford Health is the largest nonprofit rural healthcare system in the nation. It has 45 hospitals and 289 clinics in nine states and four countries. It employs more than 28,000 people, including more than 1,300 physicians in more than 80 specialties. As Sanford Health grew and acquired new services, it realized that it couldn’t rely on a purely manual process to handle its collections process. Collections Optimization Manager turned out to be a profitable and otherwise satisfying collections solution. Collecting past-due bills is about money. And any business — even one focused on health and healing like Sanford Health is — must turn some of its attention to making money. But collections can be about more than that. It can be about making patients happier. It can be about figuring out who needs your help and exactly what kind of help they need. That’s what Sanford Health focused on, and it paid off. Learn more about how Sanford Health improved its process and collections success rate. Read the case study.
Yale New Haven Health is an award-winning academic healthcare system, and a big part of why its people achieve success is because they continually ask, “How can we do better?” For two years, the financial preservice team used focus groups and other feedback to learn about the financial concerns of patients and their loved ones. Then, they pursued a rigorous, tech-driven transformation to better develop estimates, identify patient payment solutions, explain billing and collections, and engage with patients. Yale New Haven Health employees and executives view patients’ financial care as an important facet of healthcare. By pairing their own dedication and know-how with Experian Health products, they’ve improved the patient experience and increased staff satisfaction. Here’s how: Create transparent, plain-language patient estimates The preservice team wanted to give patients cost estimates that were easier to understand and more accurate. Now that they’re using Eligibility, team members know exactly what procedure a patient is having and are better equipped to verify eligibility and explain the patient’s deductibles, co-insurance, and out-of-pocket expenses. For example, the team has standardized the varying (and sometimes cryptic) eligibility responses returned by hundreds of different insurance companies and other payers. Team members give patients the same clear answer — no matter how many ways payers use to describe what their plans will and won’t pay for. Find alternative payment solutions Another challenge confronting Yale New Haven Health was helping patients find ways to pay for procedures. The preservice team deployed Coverage Discovery, which can find and verify insurance coverage that patients didn’t even know they had. As patients register for their procedures, the tool searches for previously overlooked Medicare, Medicaid, and commercial insurances. Patients can sometimes avoid costly self-pay situations, and Yale New Haven Health avoids write-offs and unwarranted charity designations. Also, the preservice team is watching trends in what Coverage Discovery finds so they can spot potential problems earlier and identify payment alternatives sooner. Make it less painful to receive a bill It’s nearly impossible to achieve pain-free billing, but the confusing terms and codes found on most healthcare statements shouldn’t add to the pain. As part of its financial care transformation, Yale New Haven Health started using Patient Statements to combine hospital and physician billing into one easy-to-understand document. It even added customized messages to further explain the procedures and costs. Patients have said that they’re happy with the new design. Give patients a way to be self-sufficient Patients want an easy, digital way to evaluate options and understand what products and services cost. Healthcare is no exception. Yale New Haven Health uses Patient Self-Service to serve up a self-service portal that gives patients a greater say in their healthcare and connects them to their providers. For example, patients can set up their own payment plans (within parameters set by Yale New Haven Health). It saves time for the patients and the preservice team, which enjoys a reduced volume of customer service calls. Yale New Haven Health already had a relationship with Experian Health. It was already using Payer Alerts and Collections Optimization Manager to improve back-end revenue cycle operations. This time around, it focused on preservice processes and added Eligibility, Coverage Discovery, Patient Statements, and Patient Self-Service to its financial care system. These tools have garnered more satisfied patients, to be sure. They’ve also served as physical expressions of Yale New Haven Health’s commitment to excellence. Staff members can take greater pride in their jobs knowing they have the tools to better fulfill their patient-centered mission. A lot is said about treating the whole person instead of just the disease. By approaching financial care as an important companion to clinical care, Yale New Haven Health has discovered countless ways to answer the question “How can we do better?” Learn more about Yale New Haven Health’s patient financial care transformation. Read the case study.
As deductibles and premiums increase, more patients struggle to pay healthcare bills, and, in turn, the patient collections process becomes more and more daunting. Hospitals and clinics are now relying on debt collection agencies more than ever. At Experian Health, we estimate a 119 percent increase in this specific outsourcing over a four-year period, from 2014 to 2018. A third-party debt collection agency is attractive for many reasons. For one, it frees up your healthcare practice’s valuable resources. Also, patients with delinquent bills typically respond well to a debt collector’s call. However, using a debt collection agency does not relieve all concerns because you must consider vicarious liability. By law, your hospital or clinic can be held responsible for the debt collection agency’s actions when it acts on your behalf. To keep your healthcare practice out of legal trouble and clear of costly fines, ensure the debt collection agencies that you hire comply with relevant laws and regulations. Also, consider using tools to make sense of these complex requirements. Do You Know the Laws Controlling Debt Collection? The legal requirements governing debt collection are varied and frequently evolving. It can take a lot of work to keep up with them, but there’s a tool to help you. We’ll describe this tool in just a moment, but first, let’s review a sample of federal debt collection laws and regulations to make sure you’re up-to-date: The Fair Debt Collection Practices Act (FDCPA) limits the behavior and actions of collectors who attempt to collect debts on behalf of another person or entity. This federal law aims to eliminate “abusive, deceptive, and unfair debt collection practices.” The Telephone Consumer Protection Act (TCPA) governs interactions between businesses and their customers, including healthcare providers and their patients. In many cases, this federal law requires consent before a provider can communicate with a patient’s mobile device through automated dialing systems, such as auto-texting or “robocall” systems. The Fair Credit Reporting Act (FCRA) regulates the collection, dissemination, and use of consumer information, including credit information. The Gramm-Leach-Bliley Act (GLBA) requires institutions to explain their information-sharing practices to customers and any available opt-out provisions. IRS Code 501(r) is a federal regulation enacted by the Affordable Care Act. It mandates certain financial assistance practices in order for an organization to maintain a nonprofit 501(c)(3) status. A key provision holds many hospitals and healthcare systems accountable for the acts of their debt collection agencies. The Electronic Fund Transfer Act (EFTA) establishes the rights and liabilities of consumers in electronic fund transfer activities, as well as the responsibilities of all parties. The Truth in Lending Act (TILA) requires disclosures about lending terms and the costs associated with borrowing.
Jason Considine, Senior Vice President, Patient Collections & Engagement, with Experian Health, sat down with Joe Lavelle from IntrepidNOW at HIMSS17 to talk patient engagement. Excerpt: \"I think hospitals have spent tons of money really customizing the clinical experience for the patient over the last really 10 years and if you go into any hospital large hospital in America today, you’re going to feel like your care has been customized for you. But when you exit the care delivery mechanism and you get into the billing process, I still see providers treating patients kind of in a one size fits all method, and that’s where I see a lot of patient engagement changing from a financial perspective is using the power of information like what Experian has. We know what a patient’s financial disposition is, whether they can pay their bill or not, whether they qualify for the hospital’s financial assistance mechanism or not, and we can be more proactive in building that relationship and sending them offers to pay their bill and customize those types of engagements more appropriately for that you unique patient’s needs. We are the Best in KLAS vendor for patient access solutions, the eCare NEXT products suite. We are very focused on taking those tools that have been adopted by providers across the United States and making them patient facing. And so we have portals that can be accessed from any mobile device and from a desktop or laptop, and give the patient the ability to shop for care using self-service estimates. Pay their bill online and set up new payment plans and really communicate with their providers in the mechanism in vehicles in which they want to do it.\" Listen to the full podcast Learn about our Collections and Patient Engagement solutions.
Meet Joe—a patient who is walking into a healthcare office, terrified of the news he might hear. He is confused and overwhelmed, not sure of where to turn for help. Joe isn’t entering a doctor’s exam room – he is actually walking into a hospital’s patient registration area, waiting to receive information about how much his procedure is going to cost. Although anxious about the procedure, Joe is even more concerned about its impact on the family budget, unsure of his insurance co-payment or what will be covered. He’s worried that he can’t afford to pay a large bill in one payment. His interactions with the registration staff over the next few minutes will set the stage for the remainder of his experience with the hospital. Now, let’s say the hospital realizes the value of having caring and compassionate financial conversations with patients at the start of the patient visit. Patient access staff quickly become the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. In this instance, leveraging a data-driven approach allows staff to verify Joe’s identity and insurance coverage as well as provide an accurate estimate of his payment responsibility. The staff even can review data to assess his ability to pay and evaluate various payment plan and/or financial assistance options. Even after Joe is discharged, the hospital continues to employ a patient-centered approach to collections, using patient financial data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. Joe’s financial data places his in the “most likely to pay” segment, indicating that he would not receive a payment follow up call until (for example) day 75 instead of the traditional call on day 45. This not only saves staff time and increases successful collections, it also preserves Joe’s satisfaction by eliminating unnecessary phone calls when he is likely to pay. Joe expected the hospital’s clinical staff to be responsive to his medical needs. When he found that the revenue cycle team was equally attentive to his financial needs, his satisfaction with the entire experience grew exponentially. It was fueled by a positive encounter that eased his mind about payment and allowed his to focus on his health. Using this proactive, personalized approach, the revenue cycle team had a major impact on both Joe’s experience and the bottom line. What is your healthcare organization doing to enhance the patient experience? Comment below to share some of your best practices.
There aren’t too many situations in which an individual purchases a product or service, but is NOT asked to pay for it right away. Healthcare, however, is somewhat unique in that regard, often avoiding a retail-based experience where patients receive service, but pay quite some time later, whether in full or the balance. Not surprisingly, this approach often times adversely impacts healthcare organizations in many ways. Best-case scenario, patient payments, while unpredictable, are received, but not in a timely manner and after a good deal of effort on the collections staff’s part. Worst-case scenario, the organization is left holding the proverbial bag, forced to write off bad debt, when payment could have been received if handled differently. In between, there are poor cash collections, increased revenue cycle costs and lower patient satisfaction. Organizations can avoid this perfect storm with a more precise approach to optimizing patient revenue. By leveraging tools that empower and improve upfront financial counseling communication, healthcare organizations stay one step ahead by accurately predicting patient responsibility payments and enhancing pre-service collections. When fueled by data and analytics, these tools offer a powerful two-pronged approach to minimizing risk and driving revenue: Avoid patient payment delays. Without knowing what insurance companies allow, many providers postpone collections until payer reimbursement is received. Healthcare organizations should instead have access to the latest contract terms, payment rules and fee schedules in order to identify patient and payer responsibility much earlier in the revenue cycle. Increase time-of-service collections. By proactively using patient payment data and current payer contract terms to calculate the amount owed by the patient at the time of service, organizations can effectively collect either a portion or all of that payment upfront. In the end, data-driven estimates of patient payment responsibility allow healthcare organizations to capture more revenue at the right time and boost cash flow. An added bonus is enhanced patient satisfaction because there are no confusing bills or ongoing collections calls, enabling a more personal experience for the patient. Hospitals have an opportunity to use data and analytics to improve the revenue stream and patient satisfaction. Learn about how Experian Healthcare Patient Responsibility Pricer can improve your collections on the front end of the revenue cycle and enhance the overall the patient experience.
