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Medicaid continuous enrollment will come to an end on March 31, 2023, as the temporary provisions are decoupled from the COVID-19 public health emergency. The federal government introduced the protections to ensure individuals did not lose coverage during the pandemic, leading to record enrollment levels. But as states prepare to resume routine renewals, up to 15 million people could end up without adequate insurance. Coverage gaps could disrupt access to health services and increase the risk of uncompensated care for providers. With Medicaid continuous enrollment coming to an end, how can providers prepare? Mitigating the effects of the unwinding of the Medicaid continuous enrollment provision Under the Consolidated Appropriations Act passed in December 2022, states will have 14 months to complete renewal processes for Medicaid and the Children’s Health Insurance Program (CHIP). While 6.8 million people are likely to remain eligible, churn and administrative delays could leave some without coverage. Analysis by the Kaiser Family Foundation suggests that in recent years, around 65% of people who disenroll from Medicaid or CHIP experience a gap in coverage for all or part of the following 12 months. Some transition to other forms of coverage, but around 41% eventually re-enroll. Implementation of the forthcoming “unwinding” process largely falls to states. While the new legislation and associated guidance bring welcome certainty, concerns remain around how to avoid unnecessary disenrollment and expedite redetermination. That way, patients (and providers) aren’t left holding bills that could have been covered when the Medicaid continuous enrollment period ends. 4 things providers can do if a patient loses Medicaid coverage As patients steel themselves for the return of renewal paperwork, providers are considering how they can help patients maintain coverage and get the financial assistance they need. Digital self-service tools to apply for financial assistance can help patients access the appropriate support, with tailored payment plan options based on their individual financial situation ­­­– all through automation. Here are 4 key actions for providers to consider: 1. Find missing coverage with Coverage Discovery Healthcare providers should put automated processes in place to find any active coverage that may have been overlooked. Coverage Discovery searches for any billable government or commercial insurance to eliminate unnecessary write-offs and give patients peace of mind. Using advanced search heuristics, millions of data points and powerful confidence scoring, this tool checks for coverage across the entire patient journey. If the patient’s status changes, their bill won’t be sent to the wrong place. In 2021, Coverage Discovery identified previously unknown billable coverage in more than 27.5% of self-pay accounts, preventing billions of dollars from being written off. 2. Quickly identify patients who may be eligible for Medicaid and financial assistance A lack of clarity around enrollment and eligibility could cause chaos for claims and collections teams. How can they handle reimbursements and billing efficiently if financial responsibility is unclear? Claim denial rates are already a top concern for providers, on top of wasted time from seeking Medicaid reimbursement for disenrolled patients. Equally, patient collections will take a hit if accounts are designated as self-pay when the patient is entitled to financial assistance and charity care. It may be difficult to tell who’s who without a robust process to check patients’ ability and propensity to pay. With Patient Financial Clearance, providers can quickly determine if patients are likely to qualify for financial support, then assign them to the right financial pathway, using pre- and post-service checks. Self-pay patients can be screened for Medicaid eligibility before treatment or at the point of service, and then routed to the Medicaid Enrollment team or auto-enrolled as charity care if appropriate. Post-visit, the tool evaluates payment risk to determine the most suitable collection policy for those with an amount to pay and can set up customized payment plans based on the patient’s ability to pay. Patient Financial Clearance also runs back-end checks to catch patients who have already been sent a bill but may qualify for Medicaid or provider charity programs. This helps providers secure reimbursement and means patients are less likely to be chased for bills they can’t pay. 3. Screen and segment patients according to their propensity to pay Optimizing collections processes is always a smart move for providers, and will be particularly important when federal support ends. Collections Optimization Manager uses advanced analytics to segment patient accounts based on propensity to pay and send them to the appropriate collections team. With access to Experian’s consumer credit data, the Collections Optimization Manager segmentation models are powered by a more unique and more catered approach that includes robust and proprietary algorithms.  It screens out Medicaid and charity eligibility, so collections staff focus their time on the right accounts. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. Altru Health System also used this solution to ensure that patients who were eligible for Medicaid were not allocated to collections and their insurance was billed promptly. Over a 10-month period, more than 4,000 accounts were flagged as eligible for financial assistance, representing nearly $2.7 million. This automated process also alleviates the burden on staff, who will likely be handling greater numbers of queries from anxious patients when continuous enrollment ends. 4. Make it simpler for patients to manage and pay bills The reality is that many patients affected by the unwinding of continuous enrollment will be on low incomes. When more than half of patients say they’d struggle to pay an unexpected medical bill of  $500, providers need to take steps to make it easier for patients to gauge their upcoming bills. Digital, self-service tools such as Patient Financial Clearance can help self-screen for charity and financial assistance. Patient Financial Advisor and PatientSimple can help patients navigate the payment process with pre-service estimates, access to payment plans and convenient payment methods they can access on a computer or mobile device. Together, these tools can help providers manage the fluctuating Medicaid continuous enrollment landscape efficiently and offer extra support to patients who may be facing disenrollment. Find out more about how Patient Financial Clearance and other digital solutions can help healthcare organizations deliver compassionate financial experiences to their patients.

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Experian Health is very pleased to announce that it ranked #1 in Best in KLAS, Software and Professional Services, for two segments:  #1 in Claims Management and Clearinghouse, for our ClaimSource® claims management system  #1 in Revenue Cycle, Contract Management, for our Contract Manager and Contract Analysis product.   According to KLAS CEO Adam Gale, “The 2023 Best in KLAS report highlights the top-performing healthcare IT solutions as determined by extensive evaluations and conversations with thousands of healthcare providers. These distinguished winners have demonstrated exceptional dedication to improving and innovating the industry, and their efforts are recognized through their inclusion in this report. Congratulations to all the winning vendors for setting the bar for excellence in healthcare IT! KLAS continues to be committed to creating transparency and helping providers make informed decisions through our accurate, honest, and impartial reporting.”  Experian Health’s 2022 State of Claims survey reveals that 47% of providers said that improving clean claims rates was one of their top pain points, with 42% reporting that denials have increased in the past year. Read how Hattiesburg Clinic in Mississippi, which uses both Contract Manager and Analysis and ClaimSource, leverages ClaimSource to automate claims management and reduce denials. Learn more about how ClaimSource and Contract Manager and Contract Analysis can help your healthcare organization. 

Learn more about health insurance eligibility verification software and how it accelerates eligibility verifications, reduces denials and and much more.

As a healthcare provider, it’s important to provide patients with financial support. Learn how Experian Health’s digital front door solutions can help.

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Duis lorem ligula, fringilla in velit vitae, ullamcorper mollis ante. Integer egestas lacus nec enim gravida, quis bibendum nibh tempor. Maecenas placerat interdum orci ut auctor. Donec congue ante vitae est viverra, malesuada ullamcorper magna varius. Aliquam sit amet tincidunt nunc. Nunc non ligula et sem gravida faucibus. This is a test heading Item 1 Item 2 Item 3 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Marcus Aurelius Row 1 Column 1Row 1 Column 2Row 2 Column 1Row 2 Column 2 Testing Buttons Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. 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Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Heading 2 Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. 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Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. 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Ad litora torquent per conubia nostra inceptos himenaeos. Heading 4 Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. 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Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Related Posts How to test the Yoast Blocks Just add them to any page/post and it should work as expected How to test the Yoast Blocks Just add them to any page/post and it should work as expected What is a Yoast block? Just a SEO-based block that was configured by the Yoast team What is a Yoast block? Just a SEO-based block that was configured by the Yoast team This is a classic block test, we are testing different features and there baseline functionalities. Does this work? What about this? Can I make a list? List Item 1 List Item 2 List Item 3 What about ordered? Item Item Item This is pretty cool This is even better What about this?

Making it as easy for patients to book and attend appointments will be critical during flu season. See how healthcare providers can prepare.

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With the Appropriate Use Criteria program slated to go into effect in 2023, healthcare providers shoud implement new alerts for prior authorizations.

COVID-19 provided an unexpected use case for patient portals. In a matter of weeks, the benefits of remote patient access were undeniable. Patient portals allowed patients to schedule, register and pay for care from the comfort and safety of home. Now, as the latest omicron sub-variant triggers another surge in case numbers, providers are again reminded of the value in making digital channels available to minimize face-to-face interaction. With staffing shortages continuing and patient numbers rising, it’s worth recapping the benefits of patient portals. Why should healthcare providers prioritize patient portals? Here are 7 reasons: 1. Patient portals can be used to communicate safely with patients as Covid-19 cases rise Health officials may be cautious about reinstating extreme measures in response to the latest wave of infections. However, they can’t afford to be complacent about an uptick in hospital admissions. Patient portals can mitigate the risks associated with increasing foot traffic by allowing patients to schedule and register for care without attending in person. Completing paperwork from home eliminates the need for patients to share clipboards or sit in stuffy waiting rooms, while online scheduling platforms enable staff to manage the flow of patients safely and efficiently. Remote patient monitoring, secure messaging and online prescription refill requests can also be managed via portals, further reducing the need for in-person visits. 2. They can ease pressure on understaffed teams Providers need to find efficient ways to handle the administrative workload that comes with higher patient volumes. It’s even tougher given increasing retirement and resignation figures. More nurses are embracing the occupational benefits of remote and virtual care and are opting to switch from high-stress facilities to telehealth positions. While this speaks to the growth and impact of remote healthcare, it leaves a gap to be filled in hospitals. Patient portals can alleviate some of the burdens by reducing the need for staff input at various points in the patient journey. For example, online scheduling reduces the number of calls to call centers. Pre-filled data and automated registration can reduce the risk of errors during patient intake, which are time-consuming to fix. Portals can also be used to help patients navigate the payments process, speeding up collections and reducing the time staff spend chasing payments. 3. Patient portals can address inefficient patient access workflows Because patient portals are tethered to the patient’s electronic health record (EHR), they provide a hub for every piece of data relating to the patient. Patients can access that golden record at any time. They get an engaging and transparent experience, and are less likely to call up to ask questions – they already have the answers. They can also check data to make sure that it’s accurate, which helps avoid the delays and misunderstandings that cause friction for patient access teams. It’s important to ensure that the portal itself doesn’t introduce friction. Patients need to be able to enroll in the portal without too much trouble. Automating the patient enrollment process and implementing a multi-layered identity-proofing solution can create a secure and efficient way for patients to get the most out of their portal, without compromising safety or efficiency. 4. To improve patient engagement and meet consumer expectations One of the biggest reasons to invest in patient portals is because patients say they want them. Research from Experian Health and PYMNTS found that 44.1% of patients have obtained test results through patient portals, while 18% used patient portals to fill out forms for their most recent healthcare visit. Overall, two-thirds said they use patient portals. Beyond offering a convenient patient experience, this is also a matter of patient loyalty and retention: 61% of patients say they’d consider switching providers to one that offered a patient portal, which could have a significant impact on revenue. 5. They can boost revenue by offering easy ways to pay Experian and PYMNTS research shows that around a fifth of patients uses their portal to make payments. Unfortunately, 16% of those patients said they’d faced difficulty viewing invoices, setting up payment plans and making payments through their portal, which suggests some room for improvement. Experian Health’s Patient Payment Solutions solves these challenges. A range of self-service, mobile-optimized tools simplify the patient financial journey by giving patients upfront pricing estimates, personalized payment plans and easy ways to pay. 6. Using patient portals can improve health outcomes (especially for “frequent flyers”) Patient portals also play an important role in promoting better health outcomes for patients. Research shows that when patients have access to their medical information, they feel empowered and prepared to speak to their doctor and adhere to care strategies. Multiple providers can engage with the patient through the same platform, and see what other treatments are being prescribed. This helps improve communication between the patient and provider and helps improve care management. It’s especially useful for older patients and those with chronic conditions. In this way, portals support effective care coordination, helping value-based care providers achieve their goals of reducing healthcare costs, promoting population health and closing the gaps in care that have widened over the last few years. 7. Patient portals can support compliance with price transparency regulations Finally, portals offer a route to ensuring compliance with new regulatory requirements around price transparency. The No Surprises Act and hospital price transparency rule call on providers to give patients accurate, upfront cost estimates so they can plan for their financial responsibility more easily. Patient Payment Estimates can be delivered in several ways, including through patient portals. And as noted, once the patient has their estimate, they can also be directed to easy and convenient payment methods, including through their portal. Whether it’s a surge in COVID-19 cases, rising inflation, or labor shortages, providers must find ways to build resilience, stay competitive, and continue to offer patients the flexible and transparent healthcare experience they desire. Patient portals should be part of the plan to open the digital front door. Contact us to find out how Experian Health helps healthcare organizations deliver a reliable and secure patient portal experience.

Discover how Dayton’s Children Hospital used PatientDial to boost collection rates and streamline patient communications.

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