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In the 1930s, Ovaltine offered listeners of the Little Orphan Annie radio program a membership badge with a decoder ring that allowed listeners to replace numbers with letters and figure out secret messages – which usually urged them to drink Ovaltine.. Fast forward to 2015, and a decoder ring can be bought online for under $20. Unfortunately, these trinkets aren’t sophisticated enough to help practices and hospitals decipher reimbursement contracts and identify underpayments. Providers today require robust analytics and automated workflows, coupled with a level of support that goes far beyond an instruction manual to include continual updates to contract terms by skilled contract analysts. According to the American Hospital Association, combined Medicare and Medicaid underpayments were $51 billion in 2013. Private payers further contribute to underpayments, totaling a hefty financial gap for providers, regardless of care setting. It is imperative that providers across hospitals and medical groups take proactive measures to ensure they are paid fully and fairly for the care and services delivered. Incorporating automated solutions enables providers to fully decode the hidden “catches” in contracts while recovering underpayments. Understand how proposed contracts with payers affect your revenues When a payer assures you that proposed contract changes will benefit your organization, are you skeptical? Using contract analysis and modeling, you can accurately predict how a change in any of the hundreds of variables in third-party contracts will affect reimbursement for your precise mix of services. Not only can contract analysis let you see the overall impact of an individual contract, it also lets you precisely model revenues so you can see the gains or losses for each individual specialty, provider or service. By assessing which factors have the greatest impact on your reimbursement, you can refine your bargaining strategy to negotiate better-performing contracts.  Verify the accuracy of payment received from third-party payers Ensuring your contracts are as advantageous as possible is just half the battle; you still have to confirm that payments follow the guidelines of the contract. Complicating this process is the move to new reimbursement structures that bundle payments or base them on value rather than services. Verifying payment accuracy can easily bog down your team–unless you put the benefits of automation to work for you. Contract management and analysis solutions streamline workflow by auditing claims so you spend time only on those that require intervention. Through data-driven insight, you can conduct contract-based appeals and recover lost revenue. Together, these solutions assist in reviewing and modeling contracts, and then accurately identifying, appealing and recovering underpayments. With the ability to value the claims you file and evaluate overall contract performance, you decode the information locked away in data. All without a decoder ring. Don’t miss our upcoming webinar, “Overcoming the Three Ps: Payers Who Pay Poorly” Featured Speakers: Kristen Prenger, Director of Managed Care, Lake Regional Health System Rebecca Charo, Product Director, Experian Health Date: Thursday, May 21, 2015 Time: 11 a.m. PT/1 p.m. CT/2 p.m. ET Register now!

Financial assistance and charity screening in the age of the Affordable Care Act

As discussed in part one of this blog series, technology such as patient portals are changing the way physicians are interacting with patients and how those patients access their medical information. An article in USA Today quotes the American Academy of Family Physicians on usage: 41% of family practice physicians use portals for secure messaging Another 35% use them for patient education About one-third use them for prescribing medications and scheduling appointments While intuitively it might seem that online interactions would distance physicians and patients, the reverse is actually true. Researchers found that patients who had online access to their physicians and other healthcare professionals increased their use of in-person and telephone clinical services, according to a study published in The Journal of the American Medical Association. Increases in patient engagement can carry over into patient billing portals. Take Cincinnati Children’s Hospital Medical Center (CCHMC), for example. The organization decided to update its patient billing portal two years ago in the hopes that a better interface and more functionality would increase the number of families using the portal. With only a one-time notice in a paper statement, CCHMC saw adoption rates soar more than tenfold in the first year after implementing the new platform. CCHMC, which is consistently ranked in the nation’s top five children’s hospitals, also experienced an increase in collections of 10-15%, and a five-fold increase of online payments, up from $200,000/month to $1 million/month. The patient-friendly portal now has more than 22,000 families using its self-service functions. The portal gives users 24/7 online account management, along with the ability to schedule appointments, pay bills and access lab results. Families now have anytime, anywhere access to their account, an important benefit for busy families trying to cope with a sick child. In conjunction with the online portal modernization, CCHMC also gave its printed patient statements a facelift. Not only did patients find the previous multi-page statements confusing, it had become increasingly expensive and time consuming to make even minor information changes and updates. Altering something as simple as a phone number or office hours could cost thousands of dollars in custom programming fees. The adoption of a new patient statement solution has given CCHMC the ability to make statement changes in house, eliminating custom programming while also reducing mailing expenses. In the first year, CCHMC saved $70,000 on their monthly invoicing due to lower printing and mailing costs, reducing the statement size from two pages to one and receiving discounts on postage. With patient experience and engagement a top priority for providers, it’s critical to consider a similar approach that works for your organization—an approach that will help patients be more active participants in their health, as well as support your clinical and financial goals. CCHMC will discuss its experiences with patient engagement, administrative savings and lessons learned at our January 28 Webinar, “Improving the Patient Billing Experience Through Online Customer Self-Service.” Register now to attend.