Tag: value-based reimbursement
As healthcare in the United States shifts toward a more value-based model, reducing readmission rates has become one of the biggest challenges healthcare organizations now face. Last year, approximately half of all hospitals in the country collectively lost more than $500 million in reimbursements because they had not learned to overcome this roadblock. In most cases, the difficulty doesn’t stem from provider inadequacy, but rather from the inability to effectively coordinate patient care among multiple providers and departments. From treatment specifics and aftercare instructions to prescriptions and follow-up visits, there are plenty of cracks in the communication pavement for important details to fall through. Here\'s the unavoidable fact: Suboptimal care coordination results in higher readmission costs to hospitals, even for patients with highly treatable conditions. In turn, providers lose much of their profitability, which further hinders their efforts to improve quality of care. Two key (and often missing) factors in care coordination are advanced IT strategies and patient engagement. The only connection among inpatient, outpatient, and long-term care teams is the patients treated in each. Therefore, providers should make it easy for patients to be proactive in their own healthcare. In large part, that requires technology that allows all patients and their care teams to communicate easily and securely, at any time and across any device. Modernizing healthcare communication while reducing hospital readmissions If healthcare providers could simply call or instant message each other with details about patients’ medical conditions, then coordinating care wouldn’t be as strenuous. Without a secure platform, however, healthcare providers might leave sensitive patient health information out in the open for anyone to steal. That liability would be multiplied among numerous physician groups, specialists, skilled nurses, home health aides, and more, possibly affecting several cities and states. All of that is in addition to hazards created by patients who log into public Wi-Fi networks and carelessly leave their mobile devices unattended. There are a lot of elements to consider, but providing a safe and convenient communication platform for patients and their healthcare teams eliminates most security concerns. With a care coordination platform, communication is protected across a broad provider spectrum, no matter what device is used. For example, after a patient is released from the hospital, the Care Coordination Manager generates and delivers real-time messages to members within the patient’s care continuum. These messages, which include discharge details, a checklist for contacting the patient, and schedules for future visits, are automated and delivered within a closed-loop system for optimal safekeeping. Better coordination equals fewer readmissions Closing communication gaps between patients and care teams is a big factor in reducing hospital readmission rates. With this in mind, as a rule-driven platform, the Care Coordination Manager automatically sends email or texts to patients and caregivers about meaningful events. By doing so, patients and their teams stay on the same page at all times with notices for completed test results, newly prescribed medications, and schedule or treatment adjustments. With the platform\'s two-way, real-time communication capabilities, patients can also ask questions and receive answers about their conditions almost immediately. This helps keep patients informed and engaged, and it encourages them to seek self-care solutions rather than visit the hospital repeatedly for minor concerns. In addition, different providers on the team can easily request information from each other. The Care Coordination Manager is unique and requires virtually no additional training for doctors and staff to utilize. The platform offers all of the benefits of secure, automated communication without the time-consuming catch-up training that often comes with implementing new systems and processes. Of its many advantages, however, the most significant is that the Care Coordination Manager patches up the cracks in care coordination and communication where important patient care information often gets lost. When patients and their healthcare teams can connect and discuss sensitive health information without the worry of security and efficiency, the better care becomes. As a result, organizations can reduce readmission rates across the board, which equally benefits patients and healthcare institutions, all while keeping the main goal of providing quality care top of mind.
Almost every day, new developments come from Washington, D.C. regarding the U.S. healthcare system. From the Affordable Care Act and Medicaid expansion to laws and regulations governing cost transparency and debt collection — there\'s constant fluctuation. This affects healthcare organizations across the country. They don’t know what rules they’ll be operating under in the future, but they do know they’ll have to meet these changing laws and regulations to avoid fines or lost revenue. Consequently, a crucial question emerges: How do you comply without overburdening employees? Compliance with laws and regulations: 3 ways Experian Health can help The answer is in technology. Healthcare organizations need systematic changes and IT solutions that help establish stability and security. For example, Experian Health’s data-driven technologies help organizations remain compliant with laws and regulations while improving the population\'s health and ensuring more successful collections. Here are three ways Experian Health can help: 1. Early and accurate cost transparency Nearly 30 states have current laws and regulations that require and govern healthcare price transparency. This list will continue to grow, so organizations need to thoughtfully prepare. Even if it weren’t legally required, patients are now demanding more transparency as they bear more healthcare costs. Historically, the problem stems from patients not receiving accurate, upfront cost estimates. They’re surprised and dismayed when medical bills arrive weeks or months after treatment. If patients are unable to successfully budget for these high costs, then collecting payment becomes more difficult. Experian Health’s Patient Estimates solution solves this by producing fast, highly accurate estimates based on a variety of data. Employees don’t need to manually update price lists, which eliminates the guesswork that leads to outdated, inaccurate estimates. Patients can even self-request treatment estimates through a self-service portal or mobile app. When patients know what to expect before they receive treatment, they’re more willing and able to adhere to payment plans. With our Power Reporting feature, organizations can also accurately judge potential and actual revenue recovery to vastly increase the rate of successful upfront collections. 2. Ensured compliance of third-party vendors Accurate and upfront estimates make capturing revenue easier, but they don\'t eliminate the need for collections. With patients paying higher percentages of medical costs, healthcare organizations now rely more on agencies to collect debt on their behalf. However, if an agency doesn’t comply with all healthcare laws and regulations that govern debt collections, then it could be liable for its practices. The Fair Debt Collection Practices Act (FDCPA), the Telephone Consumer Protection Act (TCPA), and the Truth in Lending Act (TILA) are examples of these regulations. In addition to maintaining overall compliance in your organization, being responsible for a collection agency working on your behalf can be burdensome. This burden increases when a large percentage of your patients live out of state, making them harder to manage. 3. EMV-optimized payment solutions With more payments coming directly from patients, the risk of credit card fraud is exponentially higher. Healthcare organizations can be held liable for any fraud that occurs on their watch if they haven’t upgraded their systems to be compliant for EMV payments. To help avoid credit card fraud or liability, we offer state-of-the-art card acceptance devices. These are powered by our PaymentSafe technology to provide a patient payment solution that is highly secure and EMV-ready. Because PaymentSafe is processor agnostic, it can be integrated with Experian Health’s eCare NEXT suite of products to leverage the data created at other points in the revenue cycle. It also works in a standalone environment and can be used at a kiosk, through a patient portal, or on a mobile app to accept all forms of tender. PaymentSafe and other Experian Health solutions make up an advanced, integrated revenue cycle that consumes and displays information from a wide variety of sources. The goal is to increase collection opportunities and cash flow, lower the costs of collections, allow staff members to use their time more efficiently, and increase patient satisfaction. It also makes it easier to adapt to compliance regulations that can only be met with the help of advanced technology. The country\'s healthcare laws and regulations may be in flux, but Experian Health continues to help hospitals and medical groups keep up with safe and secure solutions. By providing increased price transparency, better oversight over debt collectors, and highly secure payment solutions, Experian Health’s suite of products can make navigating complex compliance laws and regulations a breeze. For more information about current laws and regulations in the healthcare industry, please visit: S. Department of Health & Human Services — Laws and Regulations overview Health Insurance Portability and Accountability Act (HIPAA)
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.
There has been a lot of uncertainty with regards to what the future holds for healthcare in the U.S., but the reality is that the move away from transaction-based services where providers are paid by transaction or by interaction with their patients, into a world where some of those services will be paid as bundles, is a reality. At Experian Health, our perspective is that there isn’t going to be one single form of payment. There isn’t going to be only fee for transaction or only fee for value type payments. There is going to be a variety. And our solutions can help providers handle that. When we talk to our largest providers, they want to make sure that they are prepared for the future of healthcare, and that their payment and revenue cycle is robust enough that they can handle whether it is a fee for transaction interaction with the provider or with the patient as well as fee for value. In order to do that, they have to optimize their operations. There is a lot of belt tightening happening in the industry and people are trying to see and understand how best to organize, how best to analyze and facilitate that payment cycle. We believe that data and analytics are two of the key ways to do that. Our software tools as well as the data that we embed into that software helps optimize the revenue cycle. Listen to the complete podcast
Episode management, particularly the 30-90 days post-discharge, is incredibly important for all types of healthcare entities seeking to succeed under value-based reimbursement. Millions of dollars in revenue, shared savings, and bundled payment contracts are at-risk when hospitals, ACOs, bundled payment conveners, and others don’t have visibility into their patient’s care after hospital discharge. Leading health care organizations are realizing the solution is not simply to hire an army of care managers, but rather, to supplement a care management team with focused automation to double or triple their productivity by sharing workflow and care management with the patient’s community providers, including independent MD offices, skilled nursing facilities (SNFs), home health agencies (HHAs), and others. Having the right care solutions in place is critical to ensuring successful episode management. View our on demand webinar to learn care coordination best practices and find out how Experian Health’s innovative solutions can help your organization: Reduce readmissions and manage episode/post-acute costs Maximize Medicare reimbursement, minimize Medicare penalties and, hopefully, earn bonuses Profit at and contract for bundled payments Maximize commercial reimbursement Improve outcomes and lower costs for greater fee for value (FFV) in the future Learn how Experian Health can help you success in the new FFV environment. Access our on demand Episode Management webinar.
