Tag: Revenue Cycle Management
Experian Health will be at HFMA ANI again this year–booth 1025–at the Venetian-Palazzo Sands Expo in Las Vegas, Nevada. Kristen Simmons, Senior Vice President, Strategy, Innovation, Consumer Experience, and Marketing, with Experian Health, chatted with Joe Lavelle of IntrepidNOW to provide her insights on this year’s HFMA ANI conference, consumerism in healthcare and much more! Excerpt below: Experian Health booth activities \"[In our booth this year at HFMA ANI, we want to focus] around peer to peer learning and exchanges, so we are doing less selling and more engaging and more understanding. Understanding folks problems and helping to collectively arrive at solutions. We are doing a lot this year in terms of hands on demos of our solutions. We\'ll be showing some of our patient engagement products which include, self-service portals and mobile options for getting price estimates for applying for charity care, and setting up payment plans. Likewise, on the revenue cycle management side to automate orders with patient access functionality, contract management claims and collections, all those types of things that we do to improve efficiency and increase reimbursement for our clients. We\'ll also be showing off some of our identity management capabilities to match, manage, and protect patient identities so we can safe guard medical information and reduce risks for our clients. And on the care management side, our early support and sharing of post acute patient care information to help providers succeed as we all move forward into a value based paradigm.\" How Experian Health is addressing the need for consumerism in healthcare \"When it comes to consumerism, it\'s interesting when you\'re a company that has a lot of data and a lot of capabilities to say, \'Hey what can we do for people?\' One of the things we really wanted to look at for our consumer approach, was to say, \'What is it that needs to be done?\' We had some great hypotheses coming in and a lot of those were borne out but we actually undertook a big national study to take a look at what consumers biggest pain points were. It has a qualitative and a quantitative component. But, we basically looked at the entire healthcare journey so we weren\'t just asking them about the administrative and financial aspects of care, but also the clinical aspects. As we walked through the journey and were able to get a lot of quantitative data about all these different aspects of their healthcare journey, what actually turned out to be the most painful for the most people, were all the things around the financial equation. And, so clearly there can be pain in a clinical side, especially if you\'re unhealthy, you\'ve got something chronic, you\'ve got something terminal. There\'s all kinds of awful situations there but, really affecting almost everyone is a lot of the pain around the financial aspect of healthcare. So, we were able to look closely at some of those pain points and decide on some of the biggest ones that we wanted to tackle.\" How Experian Health is helping providers address financial pain points for patients and providers \"Some of the big pain points for people is just the fact that you don\'t know what you\'re going to owe and as the patient portion of responsibility increases, understanding what you\'re going to be paying becomes more and more important to a consumer. So, understanding what I owe earlier, being transparent, and then helping me pay, those are some of the areas. And there are others but those are some of the absolute biggest pain points. And as you pointed out with some of our propensity to pay analytics, and some of the other capabilities that we have, we\'re able to help providers understand the financial situation patients are in much earlier in the process so they can get them to the right kind of funding sources. They can give them peace of mind so that they know what they\'re paying upfront, which may impact when they choose to go in for a major procedure or how they might want to save up for it or how they might want to access different funding sources.\" Listen to the full podcast
Last year, a Kaiser Family Foundation study revealed that employer-based health insurance deductibles in the U.S. were at an average of $1,505. In 2006, the average was only $303. During this span of 11 years, the majority of responsibility for healthcare costs shifted from insurance companies to patients themselves, and many are still reeling from the sticker shock. Before consumerism and routinely high deductibles, healthcare providers focused most of their collection efforts on health insurance companies. Now, patients are a main source of providers\' revenue, and some organizations are struggling to fit their old revenue cycles into the new payment landscape. However, many patients aren’t prepared for the increasingly high costs of healthcare, so they may opt to delay their care until they’ve met their deductibles at the end of the year. This creates a volatile and unpredictable revenue cycle in which organizations are slow in quarter one and quarter two and then slammed in quarter three and quarter four. Other patients could forgo medical care altogether, cutting down revenue for providers. Both scenarios contribute to a less healthy general populace and a vicious cycle in which more patients need increased care but most of them continue to hesitate or refuse it. At Experian Health, we recognize and want to bring change to this unstable healthcare climate. Our healthcare price transparency tools take sticker shock completely out of the equation by stabilizing the revenue cycle and putting transparent pricing in healthcare and payment options at the forefront. Applying consumerism to transparent pricing in healthcare Healthcare might have been a bit slow to catch up, but modern consumerism has already changed virtually every other industry. Today, consumers demand to know what they’re paying for and exactly how much before any transactions are complete. They need payment options that make their lives simpler and the ability to manage their accounts conveniently online without jumping through hoops. All of this is possible for healthcare organizations to provide, but they must be proactive in helping patients overcome the burden associated with modern healthcare costs. From financial education to flexible financing programs, any organization can improve patient satisfaction by providing transparent price information and affordable solutions upfront. With that goal in mind, Experian Health offers a variety of healthcare price transparency tools that can set your organization on the path to financial clarity, education, and advocacy: Patient Estimates A high medical bill is stressful alone, but it’s infinitely more so when the amount of the bill far exceeds what a patient expected. Price transparency is paramount to overcoming that stress. It’s also mandated in several states and will soon be in all others. With Patient Estimates, you can deliver transparent pricing in healthcare to every patient before or at the point of service. Our Patient Estimates tool automatically generates estimates based on treatment costs, payer rates, and a patient’s eligibility for benefits. The platform takes the guesswork out of the process by automatically storing and populating this information so you can provide patients with highly accurate estimates as early as possible. Patient Statements When patients know what price to expect on their medical bills, they’re more prepared to pay them. Yet if they can’t read or understand the bill, they might still delay paying it until they have time to thoroughly address any concerns. To simplify the final bill, we offer Patient Statements software that combines separate billings into one simple, easy-to-understand statement. Patient Statements not only simplifies a patient’s bill, but it also helps you turn it into a valuable engagement tool. Every statement can be personalized with educational information about the patient’s condition, links to relevant videos and websites, and marketing messages for products that can improve the patient’s quality of life. Patient Self-Service Consumers are used to going online and managing their finances from a smartphone or computer. They often choose retailers based on this availability, and soon, most will choose healthcare providers on the same basis. Giving them convenient, 24/7 access to their healthcare accounts through Patient Self-Service portals will become increasingly more important for organizations to stay competitive. An online, self-service portal allows patients to view their estimates, manage their integrated fundraising accounts, pay their bills, and stay up-to-date with changes to their healthcare. Our self-service healthcare price transparency tools are also protected by highly secure payment processing technology, so patients can be confident that their information is closely guarded every time they interact with the platform. PaymentSafe® Collecting healthcare payments requires the combined security of protected health information and a patient’s personal and financial data. Our comprehensive PaymentSafe solution makes it possible to safely and conveniently collect payments at any point in the care cycle and from any department within the organization. Every payment is automatically settled throughout the system, as well, so patients are never double-billed. PaymentSafe also applies to every type of remittance — from electronic checking and debit cards to cash, checks, and money orders. In addition to satisfying information safety compliance standards, the technology gives patients peace of mind and encourages them to be more proactive in settling their healthcare bills. Transforming your revenue cycle to make it more consumer-centric and price transparent can seem like a daunting task, especially in an industry in which every small change has resounding consequences. At Experian Health, we’ve made it our mission to make that transformation easier by helping organizations provide the healthcare price transparency tools and payment options that their patients demand.
No two healthcare organizations are the same. Each has varied workflows that optimize efficacy and overall care for patients. That’s why healthcare software solutions should never be considered one-size-fits-all approaches. It isn’t fair, or terribly productive, to force healthcare organizations to adapt to new software. Rather, the healthcare software should adapt to them. At Experian Health, we’ll never supply a software product and then expect you to adjust workflows to suit it. Instead, we embed ourselves into your company to ensure we deeply understand your productivity needs and the reasons behind them. Only then can we tailor the solution we provide around you. It’s never too early to get it right The conversation about customizing your healthcare organization\'s solution begins before you even sign up. As soon as a solution interests you, we’ll start looking at how to tailor it to your unique needs. We’ll hold a meeting that includes subject matter experts and implementation leadership groups to uncover your greatest usability needs. Then, we’ll document those needs to better prepare whoever runs your project and ensure he or she has all the necessary information upfront. Then, gears start moving during the sales process. After choosing a solution, our team of experts works with members from every department in your organization to iron out the appropriate design and functionality details. We believe the people who will be using and relying on the solution every day should have a significant say in these details. However, we’ll do all the legwork of actually building and implementing the solution itself. By the time we’re ready to run internal tests to make sure the software works, members of every department will already know what to expect. Consequently, when they run user acceptance tests to check whether the solution fits into their workflows, they can accurately measure the solution’s performance against their input into its design. Afterward, we can iron out any hiccups they run into before initiating the organizationwide training and “go live” steps of the process. It’s never too late to make adjustments Our deep involvement in customizing your solution also begins before you select it, and it continues long after it\'s successfully implemented. We don’t go away just because we marked you as “live.” Instead, we understand that the healthcare industry is in constant flux and you might experience operational changes that warrant additional tinkering and tailoring to our solutions. We’ll stick around for a couple of days after going live, and we’ll stay available forever after, just in case. For example, if you purchase a new physician group six months after going live, you’ll face quite an uphill battle onboarding them all into your software system and, in turn, getting them up to speed. Because the group is new, you might face opposition to bringing on any change in general. In this case, you could use help facilitating the training and the adoption of your system into this new group, and that\'s where we step in. Additionally, what if this implementation requires a work queue structure that’s vastly different from yours? If the new group operates in a different area of the state, they might also have unique rules for some of their payers. These rules have to be incorporated into their system to accommodate the patient population. None of this, though, should fall solely on your shoulders. We can worry about the system\'s features so you can focus on the operational change management aspect. For our clients, we’re always on call. This devoted availability could range from six months or even six years. Whatever the situation, we know that you’ll eventually face circumstances that your software wasn’t originally designed to address. Instead of feeling stuck and frustrated, clients can find comfort in knowing we are here for every step of the process. And beyond tailoring your solution before implementing it, we also offer continued customization to help you tackle new circumstances without compromising workflow. Overall, here at Experian Health, we understand the pressures facing healthcare organizations today, and we are eager to be partners with you in securing the best solution for you needs and guiding you through the challenges ahead.
Seven years ago, Bill\'s healthcare group invested in a new health information system, and the dust still hasn’t quite settled. Like most health information system providers, Bill\'s vendor communicates mostly through the group’s IT leader. He has to pick and choose what updates and features are implemented, and the people who work with the system daily are expected to figure out how to make the most out of it. Fortunately, Bill and the head of IT are great pals. They eat lunch together, go out for after-work cocktails, and try to bridge the gap between their healthcare software vendor and the end users on the frontline. But Bill shouldn’t have to rely on that friendship for his healthcare team members to be able to do their jobs, and it shouldn\'t have taken seven years for the software to be properly integrated. Bill\'s not a real person, and his healthcare group is fictitious, but both are archetypes of the new healthcare landscape. Constant market changes and ongoing challenges have forced healthcare systems to partner more closely with medical software vendors. However, it’s challenging to find vendors that are willing to roll up their sleeves and work alongside the end users to design solutions that are tailored to their specific needs. At Experian Health, we want to make sure the first experience your team has with our health information system products is a positive one and that you all look forward to using them every day. Your group’s success is our top priority, and playing an active role in your onboarding process helps ensure that success. Providing health information systems and the knowledge to use them The problem with the archetype of Bill is that the end users in the group had to take on the tasks of learning and optimizing the system themselves. Trainers lacked the deep level of understanding needed to create enthusiasm about the system, and overall adoption lagged. By contrast, we know our solutions like the back of our hands, so it only makes sense for us to share that knowledge and collaborate to implement those solutions through medical software training. With years of experience under our belt working with healthcare organizations across the country, we’ve heard virtually every possible question end users ask. That experience gives us the flexibility to come up with on-the-fly solutions to challenges we haven’t thought of yet and suggest ways to optimize your group’s workflow with the system. We can offer shortcuts, tips, and tricks to make the system work more efficiently for your team. Collaborative onboarding lets our clients dive deeper into learning their new systems than they could by just reading predetermined lesson plans and FAQ lists. It helps us when we help you make the medical software training go smoother and ensure all end users actually want to use the product. In fact, for the first three to five months, Experian will be a physical presence at your organization, helping with change management and the onboarding process. Personalized, effective onboarding The process differs depending on how complex your organization is and what you’re installing, but typically, collaborative onboarding adheres to the following timeline: We start the process with a formal kickoff and demo to get executive leadership and everyone on the frontline up to speed. The demo lays out what the project will look like for the group and gives everyone the chance to start considering how to operationalize it for the organization. After the kickoff, our teams collaborate with specific subject matter experts and start digging into the nitty-gritty design and functionality detail work. We really stress the importance of operational input from people who will be champions for their specific areas, not just the IT teams. These champions need to communicate the details of the system’s design to their peers. When the design is complete, we do all of the heavy lifting to build the product, and then we conduct internal testing to make sure it works effectively. Next, we guide operational champions through user-acceptance testing to make sure the product meets their needs. User-acceptance testing occurs in a real-life, day-to-day setting so users can validate that it fits into their workflow. Once we iron out any changes warranted by the user-acceptance testing, we extend training into the larger workforce and officially go live. A month later, we come back and hold an optimization workshop to observe users in action. We can answer questions and provide suggestions on how to improve efficiency even further or make tweaks to improve user processes. With the rush to adopt faster and more efficient technology, many healthcare organizations have been left in the dust to figure out how to make new technology work best for them. At Experian Health, we stick around after software implementation to make sure your entire organization can hit the ground running. Our mission is to help the healthcare industry succeed in providing better, more comprehensive care to patients, and collaborative onboarding ensures our products do just that.
This is an exciting time for our industry, and agility and knowledge are critical for your organization to Lead the Way by meeting the growing expectations of patients and keeping pace with the ever-changing healthcare landscape. Since 2004, the Experian Health 2017 Financial Performance Summit has connected business leaders to discuss innovative ideas and solutions, allowing organizations to improve their overall financial performance and increase profits. Summit 2017 focused on collaboration, idea sharing and networking, with numerous sessions on how you can take control of your organization’s road map for growth and operational efficiency. The intimate setting of Summit 2017 allowed for unique networking opportunities, one-on-one conversations with subject matter experts and numerous breakout sessions that will provide valuable insights from industry thought leaders. The three-day Summit provided hands-on learning opportunities with product experts and the exchange of knowledge with peers in an engaging environment. The agenda featured industry-leading speakers, provider- and Experian Health-led educational sessions, a dedicated leadership track, one-on-one training, networking lunches and receptions, and evening events featuring live entertainment. Break-out sessions at the Summit covered: Claims Collections Contract Manager Patient Access Patient Engagement Price Transparency Thought Leadership If you attended the Financial Performance Summit about would like to download any of the presentations, they are available here. If you would like to attend one of our future events, please contact us.
Healthcare has always been driven by data, and today, providers have access to an unprecedented amount from a wide variety of sources. While this influx could be a blessing to the healthcare industry as a whole, it also poses a number of challenges, particularly when it comes to patient identity management. With a soaring volume of patient information coming in from numerous sources, identity errors become increasingly more likely, as well as the potential consequence of fatal mistakes. Keeping this in mind, the importance of effective identity management cannot be overstated. Every year, an estimated 195,000 people die due to medical mistakes. More than half of those deaths – 10 out of every 17 – are the result of identity management errors, such as duplicate records and mistaken patient identities. While current healthcare IT solutions attempt to tackle these discrepancies, they only succeed in identifying about 10 percent of all duplicate records. Consequently, patients often undergo repeated tests or receive incorrect treatment or medication that can result in adverse effects to their health. Also, there is limited coordination of patient data throughout the healthcare ecosystem. The main culprit of this is the lack of secure data transfers that compromise patient records and identity. This raises the question: How can healthcare organizations better manage the massive amounts of data related to each patient’s medical identity? Luckily, such issues can be improved with Experian Health’s Universal Identity Manager (UIM), which creates a single identity for individual patients across multiple disparate healthcare databases. Upgrade your identity management system The ability to share patient information across multiple healthcare organizations with different care management programs is at the core of optimizing overall patient care. Properly utilizing patient and population health data can dramatically improve an organization’s efficiency, raise its quality of care, and lower its readmissions rate. For patient data to be useful, however, providers require a robust infrastructure that allows for secure, precise, and accurate storage of patient data. The same framework should be able to assign patients unique identities across the entire network. In turn, a single, universal patient identity system allows for better analytical insights and more effective care personalization. This kind of management system also allows an organization to add relevant data to a patient’s medical profile faster and more accurately, creating an improved dynamic database that can develop personalized patient engagement and care plans. How Experian Health’s universal identity management software helps Administrative slip-ups in healthcare can have drastic consequences for a patient’s health and wellbeing. Eliminating these inaccuracies is the main goal of Experian Health’s UIM solution. Experian Health has the benefit of leveraging data assets available to us from being part of broader Experian. As a result, the identity management software generates and assigns a unique identifier to each patient that remains consistent across various healthcare systems, such as hospitals, therapeutic facilities, pharmacies, and healthcare payers. Drawing on decades of experience in identity management, Experian Health\'s multi-matching methodology approach eliminates duplicate and erroneous data through comprehensive search and alert processes. It provides a high degree of likeliness because it expands beyond the limitations of the conventional single-matching methodology that most health systems use today. Even records created on disparate healthcare systems can be automatically analyzed and assigned to the appropriate patient identity. In addition to eliminating discrepancies that could affect the quality of patient care, universal identity management also reduces medical and billing errors, ultimately minimizing an organization\'s risk of fraud. The solution also works in tandem with Experian Health’s suite of patient engagement and transparency tools, including its Patient Self-Service portal, to further optimize an organization’s ability to deliver personalized, high-quality care. Unique patient identifiers are critical for healthcare organizations to reduce the risks of inaccurate and duplicate records that lead to errors and low-quality care. Combined with Experian Health\'s suite of patient engagement and price transparency tools, its identity management software is a leap toward making efficient and reliable interoperability more possible across the healthcare ecosystem.
Uncertainty over the future direction of the U.S. healthcare system has left a high percentage of patients uninsured or underinsured. These patients rely more heavily on price estimates for care and self-payment options, and this places a heavy burden on healthcare organizations to collect patients\' payments more quickly. In addition, healthcare reimbursements are increasingly based on value. Now, providers can be penalized for giving patients inaccurate cost estimates about medical care. These estimates are taken seriously because inefficient and unpredictable revenue cycle management (RCM) that stems from errors, late payments, and other factors can cost healthcare providers up to 65 percent of their revenue. This raises a pressing question: How do you make a historically unpredictable revenue cycle less chaotic and more efficient? There are many factors to that answer, but most of them point to and lean on innovative, data-driven IT solutions, such as Experian Health’s suite of RCM tools. How can healthcare providers better predict revenue cycles? When revenue cycles are accurately predicted across the care continuum, patients can more easily pay the costs of their care, and healthcare providers can increase their collection rates. Coverages can also be identified that patients are unaware that they qualify for, helping them lower their out-of-pocket expenses and decrease healthcare providers\' risks of failing to collect payment. For predictability to matter, however, a revenue cycle needs transparency in pricing, particularly in the cost estimates patients receive before treatment. Precise, trustworthy estimates make it easier for Experian Health’s technology to generate clean claims that won’t be denied due to inaccuracies. Reducing claims denials not only allows healthcare providers to be paid faster, but it also saves the time, costs, and lost revenue of having to resubmit them. All of these factors can be challenging to address individually — and exponentially more demanding to do so all together. However, Experian Health’s goal is to relieve that weight by providing solutions designed to make predicting and managing revenue cycles a more efficient and profitable practice. How Experian Health’s solutions increase revenue cycle predictability. Boosting the ability to forecast a revenue cycle requires a variety of data-driven solutions. At Experian Health, our Eligibility, Coverage Discovery, Patient Estimates, and Claim Scrubber technologies are just a few of the many tools we provide to help. 1. Passport Eligibility Eligibility is a verification tool that combines up-to-date eligibility and benefits data for individual patients to ensure the accuracy of their upfront estimates. In turn, patients can rest easier knowing their predicted healthcare costs are accurate and derived from recent data.Additionally, the eligibility tool matches patients with Medicaid coverage that they were previously unaware they qualified for. Reclassifying patients and submitting their claims with the appropriate information lightens their stress about payments and increases a healthcare provider\'s chances of reimbursement. As a result, future revenue cycles become clearer. 2. Coverage Discovery Even patients with existing insurance may be unclear about what their coverage entails or how their plans apply to specific medical treatments. With our automated Coverage Discovery solution, hidden coverages are uncovered and applied to claims to avoid costly, time-consuming claim denials. The tool analyzes data from Medicare, Medicaid, and commercial insurance policies to help ensure patients don\'t pay more unnecessary costs. For instance, in 2016, Coverage Discovery uncovered a total of $1.8 billion in hidden coverages for more than 275 Experian Health clients. With a stronger understanding of what coverage applies to patients, healthcare providers will gain better forecasting knowledge of the pain points in patient pay, which increases revenue cycle predictability. 3. Patient Estimates With the information collected by the Eligibility and Coverage Discovery tools, our Patient Estimates platform can provide highly accurate cost estimates upfront. The solution utilizes data from numerous sources and populates that data automatically for each estimate to avoid human error. Patients who know what to expect about the costs of their treatment can make better, more informed decisions about their healthcare. They’re also more likely to pay bills they’ve carefully budgeted for instead of ones that are notably higher than the estimates they expected. By understanding this cost information in advance, both patients and healthcare providers reap benefits, making the revenue cycle run smoothly. 4. Claim Scrubber Next to garnished healthcare reimbursements, denied claims are another expensive consequence of an inaccurate revenue cycle forecast. Up to 20 percent of claims are denied or require reprocessing because of inaccurate or erroneous information. Our Claim Scrubber solution eliminates such errors by autopopulating claims with data pooled from a variety of relevant sources. Claim Scrubber reviews each prebilled claim line by line for inaccuracies and then applies extensive edits based on general, patient-specific, and payer-specific data. The digital scrubbing drastically reduces the time, lost revenue, and possible penalties associated with denied claims by boosting first-time acceptance rates. Overall, with the elimination of troublesome errors, this tool allows revenue cycles to be predicted with ease. In addition to providing an enhanced patient experience, successfully predicting and managing revenue cycles are both vital for healthcare organizations to thrive. At Experian Health, we believe that strong RCM is fundamental to any lucrative healthcare organization that strives to provide the highest quality of care. With our comprehensive suite of healthcare IT solutions, the current stress of RCM can soon become your organization’s best asset.
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.
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.
