Tag: Revenue Cycle Management
Healthcare providers are relying on patients for more of their revenue as more of the burden of healthcare costs shifts to them. In fact, hospital revenue from patients’ direct payments increased by 88 percent between 2012 and 2017. At the same time, collection rates from patients who had balances over $5,000 were four times lower than those who owed less, according to a 2017 Crowe Horwath analysis. This creates problems for healthcare organizations working to keep its reimbursement rates up. This was the situation Advocate Aurora Healthcare found itself in when it decided to create a patient collections strategy. Its patient collections team was overwhelmed, attempting to manage 20 different collections agencies. The team realized that it needed to consolidate agencies, streamline patient collections, and improve the collections experience for patients from beginning to end. Reduce reliance on collections agencies through data insights To consolidate agencies, Advocate Aurora Healthcare needed a way to analyze each agency to determine the top performers, said Peter Troia, collections manager for the healthcare organization, which is comprised of more than two dozen hospitals. The organization also lacked workflows that reflected industry best practices, which hampered robust collections efforts. Employees couldn’t review the agencies\' performance (especially because it was all self-reported) and had limited access to data, few IT resources, and high internal collection costs. In-house collections could take an average of 139 days, and collections done by agencies were taking an average of 270 days. The patient collections team decided to implement data-driven technology that could automate the collections process and give it the opportunity to segment accounts and use propensity-to-pay models to help choose the right agency for the job. By determining patients\' ability and inclination to pay using data insights (including identifying potential charity accounts) and monitoring changes in their ability to pay, Advocate Aurora Healthcare is able to focus on placing the right accounts with the right resources to yield the best results. It has in-depth reporting and benchmarks to deliver actionable insights to optimize processes, forecast future performance, and improve financial outcomes. \"When we\'re analyzing our agencies, we can look at comparing their recovery rates on a month-to-month basis,\" Troia said. \"That gives me real-world business decisions that allow me to determine when do I place, how long do I place, what can I expect on a certain segmentation score, and how we can really impact different work standards to get the results we want to get.\" Advocate Aurora Healthcare was able to compare internal collections performance with the performance of outside agencies and went from working with 20 agencies to only the four agencies that had the best performance. Advocate Aurora Healthcare Results Leveraging business intelligence and analytics in patient collections helps Advocate Aurora Healthcare determine when to move accounts from accounts receivable to bad-debt status while giving its team insights into when an account should move from one agency to a secondary placement agency. It can prioritize inventory by segmenting and routing accounts and access performance reporting to put the healthcare organization in a good financial position moving forward. By automating the collections process, Advocate Aurora Healthcare has increased its collection dollars each year. Through the segmentation of accounts combined with outbound call campaigns, it has realized double-digit increases in patient collections every year. The more patients are paying out of pocket for their healthcare, the more healthcare organizations are going to need to work on their collections strategies. But it doesn\'t have to be overwhelming. With the right tools in place, your organization can turn things around and improve patient collections results. To read more about Advocate Aurora Healthcare’s success in patient collections, please download their success story.
Healthcare runs on revenue, and claims denials can put a big dent into the budgets of healthcare providers — between 5 and 10 percent of claims submitted by healthcare providers are denied. This adds up to billions of lost dollars each year for providers in the U.S. The good news? Ninety percent of claims denials are preventable when healthcare providers automate revenue cycle functions. In fact, providers could gain an estimated $9.5 billion by automating the claims management processes. And money isn’t the only thing to be saved — companies could also have more time to work on other processes. The problems facing one Oregon healthcare provider Monitoring claims and cash flow is difficult for any healthcare organization, as the staff at Summit Medical Group Oregon — Bend Memorial Clinic (BMC) knows. Summit Medical Group Oregon – BMC found its team consistently waiting for payer response, which often forced its overall operations to drag. After 30 to 45 days of submitting claims, if Summit Medical Group Oregon – BMC did not receive payment, staff members would have to reach out to payers to determine whether they had received the claim. They also had to determine whether the claim was in the process of adjudication, as well as any other steps the staff should take in order to get the claim processed, according to Summit Medical Group Oregon – BMC business analyst Sean Schlappy. These manual processes not only create lags in claims reimbursements, but also take up a lot of staff time. The Council for Affordable Quality Healthcare found that processing claims manually takes an average of four minutes, while processing automated payments takes an average of three minutes. So Summit Medical Group Oregon – BMC decided to implement software solutions to improve acceptance rates. The tools used for improvement One product Summit Medical Group Oregon – BMC implemented was Claim Scrubber, which ensures all claims submitted are accurate before they\'re sent to the payer. Because it can be integrated with most practice management systems, this service allows employees to set up notifications in the healthcare provider\'s work queue. It also provides detailed dashboards and reports to quickly recognize trends to improve medical coding and reimbursement rates. Summit Medical Group Oregon – BMC additionally turned to Enhanced Claim Status, which provides employees with status requests based on the payer’s adjudication time frame, improves productivity, and ensures timely and accurate payments. This tool reduces the amount of time staff members must spend interacting with the payer, and it generates work lists of claims with actionable data. By transitioning most of its coverage information upstream, Summit Medical Group Oregon – BMC was able to obtain more accurate data during the initial patient introduction and registration. Using this technology, Summit Medical Group Oregon – BMC also improved the patient experience. Using technology for clean claims After implementing Enhanced Claim Status in conjunction with other services from Experian Health, Summit Medical Group Oregon – BMC gained a 15 percent reduction in accounts receivable days and volume. And the healthcare organization now has a 92 percent primary clean claims rate, and its claims denial rate has dropped to 7 percent. Integrating several tools is helping Summit Medical Group Oregon – BMC in the long term, Schlappy says. Summit Medical Group Oregon – BMC has increased payment processing and reduced claims denials, and, most importantly, it\'s producing cleaner charges.
Hundreds of billions of healthcare dollars are spent on unnecessary or overused tests, services, or medical procedures — as much as $765 billion a year, according to the National Academy of Medicine. One group analyzing spending in Washington state found that more than 600,000 patients had unnecessary treatments, and around 85 percent of lab tests performed on low-risk patients for routine surgeries were unnecessary. Wasteful medical procedures are bad for patients and bad for business. The problem? A single patient is often receiving treatment from several providers, which makes organizing an efficient treatment schedule difficult. Patients end up with duplicate or unnecessary orders that cost everyone time and money. Adjusting organizational workflow to reduce waste Handling administrative tasks manually is a huge resource drain for healthcare organizations. Scheduling, processing registration, and manually inputting orders takes a lot of time. In fact, 51 percent of a nurse’s workload is taken up by tasks that are not directly related to patient care. For doctors, that number is lower (16 percent) but still significant. Automating healthcare workflow is key to reducing the wasted hours, but any such automation must be able to integrate into the patient workflow without disruption. Automation can reduce the time spent manually entering information while increasing accuracy and eliminating redundant orders. CHRISTUS Health is one organization that had a cumbersome manual system that administrators decided to upgrade and automate by bringing in Experian Health. Before the automation, a CHRISTUS staffer would download accounts from its system in an Excel spreadsheet form three times a day, which sucked up three hours of employee time every day. In addition to the time drain, this method was susceptible to human error and technological failure, both of which extended the hours spent on this tedious task. So CHRISTUS Health implemented technology that automates up to 80 percent of preregistration workflow for work assignments and insurance verification. This automation reduced manual intervention by identifying and presenting only the patients who need follow-up by staff in order to be cleared prior to arrival. The process now allows staffers to access and work with accounts instantly rather than wait to download spreadsheets of scheduled appointments. The automated workflow that CHRISTUS Health implemented also automated the process of tracking orders by connecting them with clinics, labs, and other ancillary facilities. Now the organization can track medications that have been prescribed by others, what tests have already been ordered, and what results have been received. Through automation, CHRISTUS Health has been able to run medical necessity, check orders for insurance eligibility, review prior authorizations, and dramatically reduce phone calls to doctors and hospitals to verify information. Not only has this streamlined the process, but it has also eliminated many errors along the way. Making change count As healthcare organizations continue to expand, it\'s important to always look to the bottom line to ensure everything is running as efficiently as possible. Systems for scheduling, staffing, discharge, and transfer can be automated, which helps keep costs down and maximize staff time. CHRISTUS Health was able to increase its productivity by 60 percent with the moves the organization made toward automation. When CHRISTUS closed accounts manually, staffers processed around 40 accounts per day. With automation, that number jumped to an average of 120 accounts. Errors have been eliminated, and the three or more hours staffers used to spend downloading and emailing spreadsheets have been reallocated to more important work. All of this has been a huge benefit for the CHRISTUS team. Eliminating waste in healthcare organizations is a benefit to everyone: patients, providers, and organizations. Cutting down time spent on things that could be automated and increasing accuracy is a goal any healthcare organization can get behind.
As of January 1, 2019, thousands of hospitals in the U.S. are being required to post an online list of the cost of their services due to a new requirement by the Centers for Medicare & Medicaid Services (CMS). However, amid growing confusion about which fields are required or what format the list of standard services needs to be in, many health systems feel this new law will only create confusion among patients. One health system described the new requirements as, “It would be like walking into a car dealership looking at a new car, asking the salesman how much the car was going to cost and having them hand you the parts catalog. Obviously, when you have the parts catalog, you don\'t know what parts are in your car or which ones you\'re going to use or how much labor is going to go into making the car.\" While posting the list of prices is required by CMS, some health systems have invested in the needed technology to make it easy for patients to shop online for care. For example, in an interview with Modern Healthcare, El Camino Hospital explains they “launched a consumer self-service tool in May 2017, after about a year of development work with Experian Health. Since then, more than 3,000 people have visited the hospital\'s website, selected one or more of about 90 medical or surgical services they were interested in, entered their insurance information, and received an instant out-of-pocket cost estimate the hospital claims is 95% to 99% accurate.” Health systems like El Camino Hospital know that patients want to avoid costly surprises, and they should be able to understand their financial obligations upfront, including deductibles and copays. In fact, McKinsey research found nearly three-quarters of participants were worried about healthcare expenditures. Legislative help The new CMS requirement is only one of a few initiatives in the works from a legislative standpoint. In an effort to help patients, some members of Congress are trying to bring attention to the topic. A bipartisan group of U.S. senators in 2018 wrote a letter to healthcare stakeholders and experts requesting information in an effort to learn more about price transparency as they considered possible legislation on the matter. Also in the letter, the senators cited the lack of state laws and regulations requiring healthcare providers to make that information available to patients. More than 40 states were cited by the Catalyst for Payment Reform and the Health Care Incentives Improvement Initiative in 2016 because they were deficient in healthcare transparency legislation. And that same report found that some patients were paying thousands of dollars more than others for the same procedures, depending which healthcare provider they used. Alleviating patient stress Transparency in billing creates more satisfied patients because they know how much they will be paying for services, which makes it easier for them to budget. Going to the hospital is usually a stressful time for patients and their families. An easy way for healthcare providers to alleviate that stress is to help patients understand their costs upfront Most healthcare organizations already have the basic data they need to use automated technology to construct estimates for basic services, including claims data, real-time eligibility and benefits information, payer contracts and charge description master (CDM) information. Experian Health has the technology to help healthcare organizations convert this information into patient costs through Patient Estimates. This kind of transparency provides several benefits to both providers and patients. Online estimates published on healthcare provider websites give patients access to the information any time, including late at night and on weekends. And these estimates can be obtained confidentially, so patients who may be uncomfortable asking about certain procedures can find that information on their own. And that helps them be more relaxed about making appointments and scheduling treatments because they have confidence they won\'t face billing surprises. This feel-better result of having prices at their fingertips has a clear benefit for the healthcare providers as well. Patients are able to plan and pay for services, decreasing unpaid balances for hospitals and other healthcare providers. Ability to budget for healthcare costs Patients who know what to expect can budget wisely and actively take charge of their healthcare bills. They go in with their eyes open, which leads to improved revenue cycle management. In the end, both the patient and the hospital get what they want. With Congress and state legislatures looking at transparency in healthcare, providers can expect to see more of these rules. Healthcare organizations can get ahead of them with software like Experian Health\'s Patient Estimates. Healthcare consumers don\'t like surprises in their billing. Price transparency gives them the information and peace of mind they need to secure healthcare services and be assured that they know what they will be paying for them. Learn more about how Experian Health can help you achieve price transparency for your patients.
Healthcare providers are always balancing a million tasks at once. The most important of these tasks, obviously, is serving patients, which can sometimes crowd out the important but thankless business functions — like keeping tabs on the insurers you\'re processing. Payers are changing their policies and practices constantly, and those changes are easy to miss when you\'re focused on everything else you have to do to keep a healthcare organization running. But if a payer policy changes without you knowing, it’s going to cost you. If your denial rate ticks up because of an unknown change in payer policy, you could end up spending thousands of dollars per year to rework those extra claims. The good news, though, is that there’s a tool that can lighten the load. Experian Health’s Payer Alerts service keeps you in the loop about the payer policies and procedure changes you’re too busy to catch. That way, instead of poring over the mergers, acquisitions, and countless other details that affect the insurance industry, you can stay focused on what’s really important — without making sacrifices to your bottom line. How it works With Payer Alerts, every notification you receive is the result of extensive behind-the-scenes work by our software. The program monitors more than 50,000 web pages that payers visit and records any relevant policy changes before preparing an alert for you. The alert contains a detailed summary of those changes and a link to the affected policy. Once you receive the alert, you can just follow the link and make the necessary adjustments to your internal procedures. But given the variety of potential policy changes, those adjustments can be tough to pin down. That’s why every alert categorizes each change by healthcare specialty, allowing you to receive the alerts most related to your organization. And the customization goes further than that.Want an email that describes all relevant administrative changes? Done. Want a web-based portal where you can identify any reimbursement issues? Easy. Regardless of what you need, the alert will be waiting for you in the right platform. Finding ROI in new information Being privy to policy changes without having to sift through insurance jargon can mean a lot for a healthcare organization. “When things change and information is always current, that’s a huge benefit,” says the director of managed care at Rocky Mountain Cancer Centers, a longtime user of Experian Health’s services. When you’re in the loop about what’s covered and what\'s not, you’ll also be in better shape to increase your revenue and cash flow. RMCC, for instance, reduced its denial rate to 27 percent in its first year using the service and has reached a $1 million ROI on the investment year over year. Payer Alerts isn’t some app that bombards you with pointless notifications every five seconds. By giving you the necessary information to make timely, strategic decisions, the software can help you start running your practice more like a lucrative business. Building the perfect defense Payer Alerts helps healthcare organizations streamline their workflow and maximize revenue through more than just its immediate features; its compatibility with other Experian Health services can provide the perfect defense against the myriad payer issues that might arise. Combining Payer Alerts with our Contract Manager and Contract Analysis solutions not only keeps you up-to-date with policy and procedure changes, but it also helps you target those changes in ways that meet your unique needs. When RMCC realized that sending out individual forms for different information was wasting time, it used its Experian Health software package to aggregate all the data from those separate appeals into a single form. This helped the company reach its efficiency improvement objectives, satisfying both patients and staff. Ultimately, you can’t fix any issues with your insurance processing if you don’t know they exist, and you won’t even know there’s an issue if you aren’t aware of the constant policy changes in the industry. While you can’t stop these changes from occurring, you can invest in a system to adapt to them and avoid the agony of having to scrutinize it all yourself. If you\'re ready to learn more about Experian Health\'s Payer Alerts, get in touch with us today. To learn more about how RMCC used Payer Alerts to increase revenue and cash flow, download the case study.
The world of healthcare, as everyone knows, can be complex. And in such a complicated system, solutions that simplify, automate, and reduce busywork can make a real difference in both patient satisfaction and workplace efficiency. Although healthcare is, by its nature, a high-touch field, there are several opportunities to allow automated software solutions to handle the basic processing tasks associated with patient management. When routine interactions with patients are automated, medical and administrative staff members can devote more of their time to the cases that need the most attention. Automated workflow solutions also simplify and reduce busywork to make a noticeable difference in patient satisfaction and workplace efficiency. Obviously, that outcome is desirable for all parties involved. It reduces costs, improves morale, and results in satisfied patients. In an ideal workflow environment, employees can personally attend to problem cases and resolve certain issues manually while an automated system handles the run-of-the-mill cases that cause administrative backlogs. Experian Health has worked hard to develop just such a system. We call it eCare NEXT®. Introducing eCare NEXT The eCare NEXT platform, using an approach called Touchless Processing™, is able to offload a number of key patient processes, including scheduling, preregistration, registration, and admissions. Touchless Processing is an exception-based system, meaning that it automatically flags patients who require manual follow-up with staffers. The system updates data in real time, and users can interact with it through either a work queue system or by responding to triggered alerts. Healthcare organizations using the system can automate up to 80 percent of human intervention in the patient management process — allowing healthcare staff to focus on larger, more important initiatives to improve the patient experience. And Touchless Processing doesn\'t just free up staff time; patients see immediate benefits as well. One of the biggest frustrations in a patient\'s experience is the inability to get a reliable estimate for how much a service will cost. The eCare NEXT system sorts through all the complex factors that affect healthcare pricing — which are often too complex for hospital billing departments to accurately estimate on their own — and quickly determines accurate cost estimates for both the patient and insurance. Efficiency results in lowered costs — and happier patients The eCare NEXT system cuts costs in other ways, too: by reducing staff training needs, by ensuring compliance, by enforcing transparency, and so on. The benefits of an automated patient management system can manifest themselves in all sorts of ways. Blessing Health System, based in Quincy, Illinois, implemented eCare NEXT and found that it reliably increased efficiency and accuracy in patient management: \"Experian Health provided our staff with a reliable, real-time registration error-alerting process. Our overall registration accuracy rate has improved significantly since implementing eCare NEXT. We now have the tools we need to be successful in one user-friendly application.\" Blessing\'s employees found that eCare NEXT improved dashboard capabilities and made it easier to view critical data, including missed estimates and copays. It was a clear upgrade over Blessing\'s previous system, in which employees manually calculated patient estimates. After adopting eCare NEXT, Blessing\'s point of sale collections increased by over 80 percent, its clean claim rate increased from 63 percent to 90 percent, and denials went down by 27 percent. And because the process had become so much more accurate and efficient, the average number of days an account spent in accounts receivable decreased by 28 percent. There’s no need to labor under an outdated administrative system that\'s certain to cause backlogs, errors, and intense frustration for patients and staffers. By offloading patient management work to the eCare NEXT system, healthcare providers can do what they do best: help people. For more information, contact Experian Health or check out our Touchless Processing whitepaper.
In the healthcare industry, transparency is everything — you want your patients to be as informed as possible every step of the way. Unfortunately, that doesn’t always happen with pricing, leaving both patients and providers unsure what the final bill is going to be. That’s where Experian Health’s Patient Estimates tool comes in. With this solution, you can provide your patients with timely, accurate projections of the costs of their care either before or at the point of service. By better preparing patients for their bill, Patient Estimates helps you avoid the underpayment problems you’re likely all too familiar with, leaving you more time to focus on providing the care that really matters. The power of accuracy The pricing process in healthcare is complicated. Constantly translating the shifting policies of insurers, suppliers, and partner organizations requires a level of attention that healthcare providers are rarely able to spare. But unless you thoroughly understand all the details that go into a pricing estimate, the only thing you can really offer is speculation. And patients are stressed enough as it is; the last thing they want to worry about is whether their costs are going to unexpectedly skyrocket once the bill comes. Each projection that comes from the Patient Estimates tool undergoes several data-gathering stages before delivering any results. Patient Estimates collects information from the patient’s insurance provider, including claims history and payer contract terms, as well as the hospital\'s chargemaster price. This data is automatically posted to a centralized work list, which can be customized by a healthcare provider depending on its needs. Imagine you need a price estimate for a patient who needs a common procedure or you’re trying to pinpoint the costs of a very specific procedure. You can narrow your search in the Patient Estimates platform to match your patient’s unique situation, and then you can easily pull that pricing information back up at any time. Most importantly, this data is equally accessible for your patients — you can print estimates in a variety of languages or customize scripts for your staff to read. As altruistic as this all sounds, Patient Estimates isn’t just a way to fulfill an ever-increasing obligation of state mandates for price transparency. Getting accurate pricing estimates slashes the time you’d spend manually updating pricing lists and scrambling to create an audit trail for a patient. By automating this grunt work and providing accurate upfront information, Patient Estimates can make your collections process easy and efficient — not two words you typically associate with collections. “The tool is really behind a lot of our success with billing and quick client payments,” says the Baylor University College of Medicine’s director of patient access. “Partnering with Experian Health has allowed us to be an advocate for our patients while also protecting our bottom line.” Patient Estimates isn\'t just a useful resource for patients; it\'s also an efficient tool providers can use to avoid age-old payment problems. After all, your organization runs on payments, and you’d hate to miss out on essential revenue because you didn’t give your patients accurate information in the first place. Bundle up Combining Patient Estimates with other Experian Health services can extend the benefits across a wider range of services. Patient Estimates connects with Eligibility, for example, to generate up-to-date benefits information that can inform a patient\'s treatment plan. It also works in lockstep with our Contract Manager solution to price estimates based on a provider’s payer contract, no matter how complicated it is. The College of Medicine at Baylor University is among the providers that use Contract Manager to analyze contracts throughout clinical practice departments. After adopting Experian Health\'s product suite, the school overhauled its internal collections strategy and generated more than 18,000 patient estimates while collecting $4.2 million in contractual underpayments it would have previously missed. Baylor has used its package of Experian Health products not only to streamline its workflow, but also to improve its patient collections rate and negotiate stronger contracts. You don’t have to draw a hard line between helping your patients and making a profit. In fact, the two go hand in hand when you take the right steps. With Patient Estimates, everybody can get on the same page. Contact our team today to find out how to boost transparency in your organization. To learn more about Baylor University College of Medicine’s experience with price transparency, please download this case study.
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.
In an ideal healthcare world, third-party payers would always make payments accurately and on time. Unfortunately, human error is unavoidable, so missed payments and underpayments happen. Identifying and correcting these inaccurate payments often falls to healthcare providers, and without a strategy to make sure payers are complying with your contract terms, these errors are bound to cause stress and volatility to your revenue cycle. There are, of course, external causes of underpayment that a provider can\'t necessarily control, such as payers misinterpreting contract terms or incorrectly calculating a payment. Providers, however, can counteract this by limiting internal mistakes like incorrect billing or failure to provide appropriate documentation. Still, it’s easy to let incorrect or late payments slip through the cracks, especially without a robust contract management system. Experian Health\'s Contract Manager and Contract Analysis tools can help providers make sure they\'re reimbursed quickly and accurately. How Contract Manager and Contract Analysis eliminate payment problems Experian Health\'s Contract Manager for Hospitals and Health Systems verifies the amounts owed for all applicable claims, monitors payer compliance, and models the financial implications of proposed contracts. And because Contract Manager’s data processing and storage is completely remote, providers get 24/7 web-based access with no capital investments required and no added cost for software or data updates. Contract Manager helped Timothy Daye, director of managed care contracting and reimbursement at Duke Private Diagnostic Clinic, part of the Duke University School of Medicine, identify underpayments and discover ways to avoid them in the future. “In addition to identifying underpayments,” Daye said, “there’s tremendous value in identifying billing issues that may result in underpayments and also identifying process improvements that can be implemented to eliminate the underpayments in the first place.” Contract Manager alone can identify and prevent late payments and underpayments, but when providers pair it with its companion solution, Experian Health\'s Contract Analysis, they can find added data and negotiating power to set contract terms that optimize third-party reimbursement. Because you don’t have a crystal ball to predict how all of the hundreds of variables in third-party contracts will affect payment, you need a contingency plan. That\'s where Contract Analysis comes in. By spotting unfavorable contract terms and offering real-world “what if” scenarios, Contract Analysis tells you exactly how proposed contracts with payers might affect your revenue cycle. You’ll know before signing on the dotted line how each part of the contract will play out. The Contract Manager and Contract Analysis combination allows you to audit payer contract performance to ensure compliance and maximize revenue. You could, for example, use it to check the accuracy of a reimbursement by comparing the expected payment to the actual payment, or you could recover from underpayments by finding lost revenue with data-driven insight. Contract Manager and Contract Analysis can also help you identify unusual causes of underpayments. For instance, when Daye and his team were working on a recent anesthesia project, they had to correct a non-standard billing situation. “The payer was taking a reduction by billing the QS modifier, which is outside of the norm of standard billing protocol,” Daye says. “We changed that process through the appeal with the payer by showing documentation that the QS modifier was informational only and doesn\'t warrant a reduction in payment.\" Had Daye and his team not been able to identify this system issue, they’d still be scrambling to determine why the payment was lower than they were expecting. However, by using Contract Manager and Contract Analysis, Daye was able to pinpoint an outside-the-norm situation and correct the payment discrepancy as quickly as possible. What makes the combo unique The Contract Manager and Contract Analysis combination is essential for any healthcare provider wanting to ensure it receives payments that are accurate and on time. By using proprietary valuation logic, these tools will give you more precise insight into your contracts, giving you a solid foundation to protect against any payment problems. Experian Health reimbursement specialists even offer complete contract maintenance to make things easier. Whether it\'s a coding typo or a misinterpreted contract item, there will always be some factor that could cause a payment error. And while you can’t control some of these unforeseen hiccups, you can use Experian Health\'s Contract Manager and Contract Analysis solutions to correct them in the most reliable, efficient way possible.
