Tag: Revenue Cycle Management
Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.
Consumers are bearing a bigger burden of healthcare costs than ever before. As the third largest payer behind Medicare and Medicaid, many patients find themselves struggling to foot the bill, with implications for hospitals and health systems. According to a TripleTree report published late last year, consumer payments will reach $608 billion by 2019, thanks to growing enrollments in high deductible health plans (HDHP), decreasing payer reimbursements, and increasingly personalized insurance plans that come at a premium. Almost half of those under the age of 65 are enrolled in an HDHP. These rising out-of-pocket payments can cast a long shadow on the patient\'s experience. The payment process is often stressful and confusing, and many are unable to pay without careful budgeting or some form of financial support. And for providers, the growing admin costs of chasing payments can create a serious cash-flow problem. A forward-looking, patient-centered approach to billing is critical. A good starting point for providers who want to reduce friction around payments, optimize revenue and build a positive relationship with consumers is to look at how data and technology can improve customer payment processes. You can do this in three ways: transparent pricing, patient billing tailored to each individual\'s financial situation, and simplified admin processes all provide greater clarity and reassurance for patients. Make patient billing easier with transparent pricing New guidelines from the Centers for Medicare and Medicaid Services (CMS) call for hospitals to list chargemaster pricing on their websites, so consumers can make informed decisions about their treatment and plan accordingly. Unfortunately, the complexity of pricing structures and the way it\'s presented can still be very confusing for consumers. CMS Administrator Seema Verma tweeted that \"While the information hospitals are posting now isn’t patient-specific, we still believe it is an important first step & sets the stage for private third parties to develop tools & resources that are more meaningful & actionable.\" Patients are encouraged to tell the CMS if they can\'t find pricing info on their hospital\'s website, using the hashtag #WheresThePrice. However, there’s been a lot of criticism that the CMS requirements do not meet consumer expectations. Health leaders should aim to provide consumers with accurate personalized estimates, using data-driven technology. Most healthcare organizations already have the basic data they need to generate estimates for basic services, including: claims data real-time eligibility and benefits information payer contracts charge description master (CDM) information. Dan Wiens, Director for the Patient Estimate Suite at Experian Health, says: \"We\'re finding facilities are getting backlogged with calls while patients are trying to call in to speak to a live person to try to get an estimate... If a patient is comfortable understanding what they owe, they\'re going to be much more comfortable paying for their services.\" Giving patients accurate estimates upfront empowers them to understand their financial responsibility so they can make quicker, better decisions, and improve their overall experience. Saratoga Hospital used Experian Health’s Patient Estimates pricing transparency tool to eliminate the need for manually updating price lists and remove guesswork for patients and staff. By creating a standardized pricing and collection approach, the hospital was able to increase cash collections by 400% from 2015-2018. Personalize patient payment plans for a better patient experience The growth of consumerism in healthcare calls for a friendlier approach to the billing process, both for a better patient experience and to avoid non-payment. This means recognizing each patient as an individual with different needs and tailoring your offer at each stage of the revenue cycle. Some will be able to pay their whole bill up front, while others might need to spread it over a number of months, or seek support from a charity. Issuing the bill and hoping it gets paid isn\'t going to cut it – you\'ll be wasting time and money on repeated, unnecessary collection attempts. Instead, why not personalize each patient\'s payment plan based on their individual financial situation? No surprises for them, no missed payments for you. Insights from credit data can help you identify the best collection approach for each patient, so you can work with them to find financial assistance, set up payment plans in advance, or outsource payment to an appropriate co-payer. Simplify the admin process to improve patient collections These days, most of our life admin is done online, from banking to travel. Healthcare needs to do the same. You can make healthcare payments easier for your patients by giving them access to their accounts online, so they can manage it when it suits them. This is about making the revenue cycle as frictionless and consumer-friendly as possible. Data-driven technology makes it easy for patients to obtain accurate price estimates, set up or modify their payment plans, check their insurance details, combine payments to different providers, and facilitate mobile healthcare payments. Terry Manifesto, a Senior Director at El Camino Hospital, worked with Experian Health to allow patients to access and manage their data through a self-service portal: \"We\'re providing a lot more estimates than we could before, because it\'s 24/7, on the go - a patient can use it from their mobile device, from their laptop, or their desktop.\" With healthcare consumerism and outcomes-based care trending upwards, the dynamics of healthcare finance are shifting. A collections approach based on compassion and simplification is the key to building trust and optimizing revenue at the same time.
For many healthcare providers, claim denials are a frustrating cost of doing business. Each year, around 5-10% of medical billing claims are rejected (possibly more). With each claim costing around $25 to rework, providers lose billions in eroded revenue and productivity. Any revenue leakage is bad enough, but the shift towards value-based care means tighter revenue cycle management (RCM) is even more important. In an environment where everyone must do more with less, reducing claim denials could release vital revenue and staff time to create breathing space for quality improvement. The good news is that while only two-thirds of denials are recoverable, around 90% can be prevented. Using technology to access more reliable data, providers can eliminate avoidable denials resulting from missing or incorrect information, duplicate records, missed deadlines or unconfirmed eligibility. As they say, prevention is better than cure. Three ways to improve RCM and reduce claim denials Automated technology can help optimize all stages of the revenue cycle so claims are right the first time, saving headaches down the line. Three areas to focus on are: Patient access – using shared systems to connect front and back office staff more effectively Identity management – ensuring patient and payer information is accurate from the start Denials workflow – enabling more efficient follow-up and analysis, to resolve denials quickly and avoid repeats. Using technology to connect front and back office With 30-50% of denied claims occurring earlier in the revenue cycle, streamlining patient access and registration can eliminate a significant slice of expensive errors. Boys Town National Research Hospital used new technology to improve communication between front and back office teams, automating up to 80%of the pre-registration workflow. More accounts could be cleared upfront, so staff could focus on claims that were more likely to cause issues. After just one year of using the automated software, all manual work was eliminated and eligibility denials dropped 20%. Clean data in, clean data out Automating rote tasks isn\'t the only way to ramp up productivity at the front end of the revenue cycle. Around a third of all denied claims are associated with inaccurate patient identification. According to a survey from Black Book Research, this costs the average hospital $1.5 million and the U.S. healthcare system over $6 billion annually. \"As data sharing grows and challenges in connectivity are tackled, resolving patient record matching issues has become more urgent and complex,\" said Doug Brown, Managing Partner of Black Book Research. When a minor error such as a wrong insurance address can wreak such havoc, it makes sense to use demographic data to guarantee accurate patient details. Duplication is another major issue. On average, as many as 12% of healthcare records are duplicates, mostly due to misidentification during registration. Reconciling these records costs around $1,000 per pair, amounting to millions of wasted dollars annually. This isn\'t just an administrative or financial concern. Misidentification leads to patient distrust, pharmaceutical abuses, and redundant treatment, which risk patient safety and drive up costs for patients and providers. Healthcare staff need to feel confident that the patient is who they say they are, with a single, complete record. Using technology that can apply an algorithm of sophisticated matching methodologies can clean up patient data and eliminate duplicate and inaccurate records. Resolve denials quickly and learn from mistakes Finally, when denials do occur, they must be managed efficiently. Schneck Medical Center upgraded its denial management process, giving staff real-time insight into how claims are progressing. Automated software identifies which claims need following up, so back office staff can now manage claims without manual review. McKenzie Smith, Director of Patient Financial Services said: \"No longer are we waiting 30 to 45 days to review denials. We can review them on the day of [submitting] if we choose to.” Insights from whole system data reporting and analytics give front office staff immediate feedback to spot issues that can be avoided in future, looping back to those preventive measures. What’s more, working with a claim scrubber that allows custom pre-billing edits will further ramp up the likelihood of achieving 100% clean claims. However, this only works if your denials management system can analyze the root causes of denials and incorporate unclear or unpublished payer rules. Prevent, manage and analyze your RCM system to reduce claim denials This is an exciting time to be in healthcare finance. Technology offers many opportunities to radically reduce revenue loss, but few providers are using it to maximum effect. Healthcare providers should shift from reactive to proactive claim denial management, looking at the whole RCM process. Ideally, this means using technology to prevent denials in the first place, improving processes for managing denials when they do occur, and then using a robust analytics platform to understand what went wrong so it can be avoided in future. But data management tools are only as good as the data itself. As in all aspects of healthcare, quality matters.
A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one. For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices. Keeping up with payer contracts In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex. The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG\'s numbers continued to fluctuate until implementing Epic alongside Experian Health\'s Contract Manager. Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster. Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.” The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials. Experian Health\'s team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA\'s contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes. Analyzing contracts before signing up In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It\'s also able to avoid unfavorable contract terms, as they are easily spotted through analysis. Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.
Healthcare organizations have been forced to deal with billing challenges for so long that many might consider the struggle to simply be the price of doing business. Denied claims and contractual underpayments are regular occurrences in the payment cycle. And these issues can cause problems in the rest of the healthcare ecosystem when left unchecked. Fortunately, a robust claim scrubbing solution can reduce costs and speed up reimbursement. Healthcare billing costs can add up quickly. The estimated cost of billing- and insurance-related jobs at one large academic healthcare center ranged from $20 to $215 per patient visit, according to a study published in 2018. For years, the State of Franklin Healthcare Associates (SoFHA) was all too familiar with the challenges of the claims process. In 2010, the organization had to keep 12 full-time employees on its payroll devoted to the correction and resubmission of denied claims. When claims are denied, Crowe reports that it takes an average of 16.4 additional days for a hospital to receive payment. And those delayed payments are costly to healthcare organizations. Without the tools that enable a proactive approach, healthcare organizations\' only option is to submit claims and then wait to correct the ones that are denied. SoFHA’s large network of 109 providers included a wide variety of specialties and services, from diagnostic imaging and internal medicine to OB/GYN and family practice. SoFHA needed a flexible presubmission claim scrubbing technology that would identify and correct errors before claims could be submitted. To overcome the obstacles in the claim submission process, SoFHA turned to Experian Health\'s Claim Scrubber. Claim Scrubber stood out to the group in two ways. The first was the price, as users pay a fixed monthly rate rather than pay for each transaction. The other highlight was the ability to build customized claim edits, which are available to all clients immediately when the tool is deployed. For Amanda Clear, SoFHA’s director of business services, that capability made all the difference. “With Claim Scrubber, I have the ability to go into the system and create my own edits,” Clear said. “Other systems either didn’t accommodate customized edits or required you to call, perhaps pay a fee, and go through a long process.” Plus, Claim Scrubber reduces demands on healthcare provider personnel because the tool comes with around 350 edits maintained by a dedicated content team. Payer-specific edits replace between 60 and 75 percent of an organization’s custom edits right away. Claim Scrubber ensures claims are correct and complete the first time they\'re submitted. Experian Health regularly updates its system with coding and payer changes. The tool adjusts for coding variances on claims submitted to Medicare, Medicaid, and private insurance companies. It reduces denials and drives down rebilling costs for healthcare organizations. With Claim Scrubber, SoFHA generated a clear return on investment, and the group was able to expedite accounts receivable by 13 percent. Perhaps even more telling was the reduction in full-time claim correction employees that accompanied the adoption of Claim Scrubber — a change that occurred in spite of a growing volume of claims. By auditing claims and spotting errors before submission, Claim Scrubber can ease the burden of claims denials and allow healthcare providers to instead focus on their job of providing the highest-quality patient care. --- Learn more about how we can help you ensure all claims are complete and accurate before submission to the appropriate payer or clearinghouse.
The burden of healthcare expenses on patients is a growing problem for hospitals and patients alike. Hospitals are losing about $7.5 billion in out-of-pocket medical expenses that go uncollected every year. And collecting patient balances has become more difficult largely because patients are struggling to keep up with rising medical costs. Insurance reforms that have produced higher copays, among other things, are putting a greater financial burden on patients. They are now expected to cover about 30 percent of medical treatment costs, but many cannot afford it. In fact, high medical expenses factor into two-thirds of bankruptcies. This means that as more patients struggle to pay for healthcare, the amount of bad debt hospitals have is rising. In a survey of 100 hospital executives, 36 percent reported that their systems had $10 million or more in bad debt. And their prospects for recovering that money are grim. The issue is that many healthcare networks don’t have the technology to handle their complex collections challenges. Martin Health System was seeking a solution to automate its collections processes for self-pay revenue. Based in Florida, the healthcare network has three hospitals and numerous outpatient clinics, as well as an emergency center. That translates to a lot of patient accounts to evaluate. Martin Health needed healthcare collection software. Optimizing healthcare collections Hospitals need to be able to analyze their records to determine which patients are most likely to pay. The right software makes that process more efficient and effective so healthcare organizations can improve their collections outcomes. Martin Health System had already optimized its registration and authorization phases but system leaders felt that it could further enhance collections efforts with an automated solution. In 2016, the network implemented Experian Health’s Collections Optimization Manager. The top priorities were segmentation, identifying charity cases, scrubbing for Medicaid opportunities, and better collection agency monitoring and management. The self-pay receivables management solution automates many aspects of healthcare collections using data analytics. Martin Health was able to optimize its collections efforts by determining how to allocate resources more appropriately and place accounts with the group best suited to collect for each account. To create a more compassionate experience, the software culls through patient data to screen accounts for bankruptcy, Medicaid and charity eligibility, patient expiration, and more, to remove the accounts that shouldn’t go to collections. Then it segments the data based on priority and treatment strategies and transfers those segments to the appropriate in-house collections department or agency. The software also continuously monitors accounts for changes in patients’ ability to pay, which is no small feature. According to the aforementioned survey of hospital executives, almost one-fifth of hospitals do not re-check patient eligibility for insurance. And even worse, one-fifth of hospitals lack any process or a third-party partner to recover bad debt. This one function alone could significantly improve hospitals’ collections efforts. Martin Health System accomplished its goal of better agency monitoring through an overview of collections progress that informed business decisions. Throughout its evaluation process, the Collections Optimization Manager provides performance reports in a real-time dashboard. And the service comes with support from revenue cycle consultants who review the data. They advised Martin Health on optimal collection strategies and suggested opportunities for improvement. Ultimately, Martin Health System enhanced its collection efforts while reducing the cost to collect. The healthcare organization also found new areas to increase collections performance. In just eight months, the healthcare organization transformed its collections performance. Having a better handle on its self-pay receivables boosted Martin Health’s overall receivables by more than $4 million in just six months. That included increasing collections by $3.1 million, and finding $975,000 in Medicaid coverage. It accomplished all of these goals by putting the right healthcare debt collection software in place. Read Martin Health’s success story here or schedule a demo to learn more.
Healthcare providers should be able to focus on what\'s important: their patients and the care they need. However, providers and their staff must spend much of their time on administrative tasks. A study by AMA Prior Authorization revealed that providers are spending two business days per week just completing prior authorizations. That doesn\'t even account for other administrative tasks. Meanwhile, providers rely on more payers and plans than ever before, which is often tied to their clinical performance, and patients are becoming increasingly more responsible for the cost of their care. This is leading to an increase in operating losses per physician of 17.5 percent of net revenue in 2017. Providers must prioritize their revenue cycle efficiency if they want to remain financially solvent in the ever-shifting healthcare field. To safeguard its revenue, Schneck Medical Center in Indiana, the only hospital serving four counties, wanted a way to optimize claims follow-up by identifying and targeting the claims needing attention as quickly as possible. This was especially important because an estimated 10 percent of the population lacks insurance and 13 percent lives in poverty in the primary county the medical center serves. Schneck\'s goals were to: Ensure denials did not exceed 3 percent of net patient revenue. Achieve the estimated total net preventable denials of $3.2 million or a 2 percent increase to operating margin. Reduce denials by confirming patient insurance eligibility, verifying medical necessity, and obtaining prior authorization when appropriate. Makenzie Smith, director of patient financial services at Schneck, said that industry pressures to reduce healthcare expenses and provide a better patient experience are what drove the healthcare organization to look at the revenue cycle technologies and processes it had in place. A better denials management system The denial management process can be cumbersome, especially for community hospitals like Schneck. It takes up too many resources and far too much time. Schneck was looking for better denial analysis reporting and automation software so it could more effectively manage denials and significantly increase collections. The organization\'s search led to Experian Health\'s automated approach to tracking the root causes of denials and identifying the trends in order to improve procedures. The software tool provided a comprehensive solution and allowed Schneck to optimize its claims workflow with remittance detail and analytics. It now helps the medical center identify denials, holds, suspends, and zero pays and uses electronic remittance advice and claim status transactions to identify appeals won or lost with payers. This allows Schneck to identify and target the claims that require immediate attention. The payoff With executive leadership buy-in and support, Schneck created a new, better process for claims denial management by: Reviewing preventable denials with customized queues in real time. Identifying directors with staff responsible for checking a patient\'s benefits and obtaining prior authorizations. Reviewing all denials over $500 in the revenue cycle department. Establishing a schedule for reviewing denials each month. Schneck\'s new streamlined process and real-time visibility into denials data has allowed staffers to work on denials more efficiently. The ability to link denials to a specific staff member in a specific department has further streamlined the process. The relationship between the front and back office has improved because both sides have achieved a better awareness of processes. With the right denial analysis and automation, healthcare organizations like Schneck can manage denials effectively and increase collections significantly.
About 8 percent of the costs involved in U.S. healthcare are spent on administrative costs. Whether it’s paperwork for a simple follow-up or processing billing for a complex surgical procedure, the costs add up immensely for healthcare organizations. It\'s a problem that Boys Town National Research Hospital knew well, according to Toni Gross, Director of Patient Financial Services. A few years ago, Boys Town Hospital staff realized they had a front-office team that was doing a lot of manual work, which was causing claims denials. The back-office team was largely focused on fixing the denials, but not communicating with the front-office staff about the common mistakes being made to avoid the denials in the first place. “The approach just wasn\'t efficient,” said Gross. “We were on a vicious cycle. Lots of denials, repeating work, repeating work, so I just stopped and finally looked at the process.” Of all the claims healthcare providers submit, 5 to 10 percent are denied, costing providers billions in the process each year. And above all, it puts pressure on a team that could be handling other tasks. It’s one of the many reasons providers like Boys Town Hospital need to overhaul their revenue cycle management metrics. Boys Town Hospital wanted to connect the front-office and back-office teams so they could focus on what really mattered: Decreasing denials and getting paid as quickly as possible. The importance of automated software But how can busy providers fulfill their mission when they’re faced with these revenue cycle management challenges? Boys Town Hospital needed an automated solution to get their organization on track. Because the front-office team had been separated from the rest of the process, they were not getting any feedback on their work. They were spending all of their time checking eligibility, and handling scheduling and registering. To reduce denials, the front-office needed a way to financially clear accounts upfront. They also needed an intelligent work queue to identify and present only those patients who need follow up by staff in order to be cleared prior to arrival, minimizing the hands-on work that bogs down operations. Boys Town Hospital decided to implement technology that could automate up to 80 percent of their pre-registration activities. While the back-office team took the lead in implementing the technology, both teams started working together to make sure they were aligned in how to reduce claims denials. In 2017, only a year after going live, Boys Town Hospital saw a 20 percent reduction in eligibility denials and eliminated all of their manual work. “The key to success was thinking about the entire revenue cycle,” Gross said. “Experian Health\'s many tools fit together to make the process seamless. Also, it\'s important to get things right from the beginning.” The team built as many edits as possible to avoid problems. When new problems come along, more edits can be inserted to avoid them moving forward. \"I call it backing up the bus,\" said Gross. \"There\'s a problem; you\'re presented with it; back up the bus. Where did it start? How can I avoid it?\" Automating the processes mean that staff only touch the claims that that will cause problems on the back end. This increases staff focus because they are not handling the same tasks repeatedly. Work smarter, not harder Healthcare revenue cycle management is a challenge — but implementing automated software can be a game changer. \"I am a support to physicians. I am a support to nurses. I want my phone to ring when they have a question about anything,\" said Gross \"It\'s my part to step over into their world, listen to them, and figure out what it is that I can do to try to make that a little bit better for them. That\'s how I make the patient experience better.\"
It\'s no secret that claim denials cost healthcare organizations. They take about 16 more days to pay out than claims that have not been denied. On average, this delay in payment equates to one percent of a healthcare organization’s cost structure. Final claim denials — or claims in which the payer never pays the provider — lowers a typical hospital’s annual net revenue by 1.9 percent. These tack on additional administrative costs because of the work it takes to close them. The good news is that 76 percent of claim denials are eventually paid off — but the staff time it takes to get the payments can be costly. Claims roadblocks Experian Health recently worked with a large healthcare organization that manages more than 200,000 claims per month, which exceeds $1 billion in claims dollars. The organization has almost 50 hospitals in its network, as well as urgent care and cancer care centers, which creates a large number of transactions and claims to process. This includes Medicare, Medicaid, private insurance, worker\'s compensation, managed care, and more. Before partnering with Experian Health, a number of errors were leading to denied claims, including discharge-not-final-billed errors, claims errors, stop bills, late charges, clearinghouse edits, and other factors that created roadblocks. But claims automation helped turn things around. Automation reduces errors Automation provides benefits to healthcare organizations and patients because it speeds up evaluation, ensures correct and timely billing, and reduces the number of manual touches needed for each claim. According to the Council for Affordable Quality Healthcare, manual processes slow down claim reimbursement. People take an average of four minutes to process claims, but automation reduces this to three minutes. Although a minute doesn\'t sound like much, it translates to thousands of hours saved for a healthcare organization that processes 200,000 claims each month. Automation also frees up time for billing teams to focus on more pressing tasks. How organizations can benefit By automating, this healthcare organization could ensure clean claims by utilizing an expansive library of national payer edits and implementing custom edits. This eased the follow-up process because teams had detailed insight into claims status, an analysis of denial reasons to efficiently process them, and automated workflow and payment posting to handle splits and contractual adjustments. One of the biggest reasons this healthcare organization partnered with Experian Health was the ease of implementation with its medical records system, Epic. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, found and repaired issues with the system build, and created opportunities for cross-training and centralized reporting. Long-lasting results Through this automated process, the healthcare organization now has detailed insight into its claims management process and can monitor rejections data, review effectiveness, and find ideas for even more system automation. Through its partnership with Experian Health, this healthcare organization has improved its claims metrics across the board. It improved its acceptance rate by 10 percent, and it became an Epic top performer for claims acceptance, averaging a 99 percent acceptance rate. It has also increased its clean, paid claims percentage by over 10 percent. Start automating to streamline your claims process.
