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Patients hit with a double whammy of rising costs and soaring inflation need to know where they stand when it comes to medical bills. Financially stretched patients often prioritize other household bills over healthcare payments, but delays can quickly spiral toward debt. When patients know their bills in advance, they’re better positioned to avoid medical debt – which is the thinking behind the No Surprises Act and other price transparency rules. Despite the benefits to providers, implementing accurate upfront price estimates is proving to be tricky. As of August 2022, only 16% of hospitals were found to comply with the federal price transparency rule, with the first financial penalties for non-compliance reported in June 2022. New measures that were recently announced will continue to address medical debt, and enforce price transparency rules more stringently. These turn up the heat on providers to find ways to simplify the patient payment experience. In a recent conversation with PYMNTS, Victoria Dames, Vice President of Product Management at Experian Health, highlighted three smart investments providers can make to help tackle the challenges associated with price transparency rules. Investment 1: Delivering accurate estimates Patients who do not see cost estimates before treatment are less satisfied than other patients. A study commissioned by Experian Health and PYMNTS found that patient satisfaction increased from 78% to 88% when estimates were available. But as Dames notes, estimates are useless if they’re inaccurate: “it's common to get an estimate today. It's less common to get a very accurate estimate.” She says that the renewed political focus on medical debt is likely to prompt investment in billing technologies to generate and deliver more accurate estimates. One such technology is Patient Payment Estimates, which offers patients a clear, accessible and easy-to-understand breakdown of what they’re likely to owe. It pulls from current chargemaster data and payer contracts and applies real-time benefits data for maximum accuracy. There’s no need for providers to manually upload price lists or call the patient to explain their estimates. It can even connect to convenient digital payment methods and provide payment plans, placing the patient in the driver’s seat when it comes to managing their financial responsibility. Investment 2: Implementing cutting-edge payment technology Dames says that once accurate estimates have been generated, the next big task is to enable consumer-friendly payment technology. She says, “Making the payment process simple and convenient will increase your likelihood for payment… it makes it easier for us as consumers to meet our financial obligations in a timely manner. A lot of providers are already in the process of reviewing and integrating technology to help support this.” Patients expect a variety of payment methods, similar to the convenient digital methods they use in retail environments. More than half of consumers say the pandemic changed how they pay for healthcare, with more choosing contactless cards, mobile wallets, online portals, and online peer-to-peer transfer services. Dames has noticed that “buy now, pay later” options are also entering the healthcare marketplace, which she believes will help to create a positive and transparent patient experience. Experian Health offers a suite of payment tools so that providers can collect all forms of payment anytime, anywhere. For example, Patient Financial Advisor brings together pricing estimates with user-friendly payment methods, so patients know what to expect and can make payments directly through their mobile devices. Investment 3: Optimizing collections with advanced data analytics Finally, Dames recommends that providers review their investments in collections optimization technologies. The goal should be to use a broad set of data to paint a picture of each patient’s past medical payments, recent financial situation, and current propensity to pay. Better data and analytics can help direct patients to the right payment plans. With more insights into each patient’s individual situation, providers will be able to see who needs more time to pay and who may be eligible for charity care. Data-driven tools such as Patient Financial Clearance can screen patients and assign them to the appropriate pathways, while PatientSimple helps patients manage their payment plans and apply for assistance if necessary. Experian Health works with more than 60% of US hospitals to improve revenue cycle management, so Dames knows that it’s a tough time for providers to update their workflows, systems and practices. When it comes to transparent pricing, Dames notes that regulations may be challenging for providers and payers. However, the subsequent investments will be instrumental in complying with price transparency rules and create patient-centered financial experiences: “The immediate path to better billing and payment processes may escalate pressures on providers right now, but it will yield better financial outcomes in the future for patients.” With the right technology partner, providers can tackle price transparency and increase patient collections. Find out how Experian’s data-driven patient estimates solutions can help healthcare organizations deliver more accurate pricing estimates and tackle price transparency rules.

The repercussions of errors on the healthcare claims processing workflow can be major and wide-ranging. It slows the revenue cycle, interrupts cash flow, consumes staff hours, creates frustration for staff and patients, and, in the worst cases, sacrifices revenue. Errors are a perennial—maybe even inevitable—problem but understanding some common reasons behind these mistakes can help. Additionally, digital claims management tools can help you automate claims processing to reduce claims errors, submit cleaner claims, and get paid successfully. In June 2022, Experian Health surveyed 200 revenue cycle decision-makers to understand the current state of claims management. Watch the video to see the results: Any number of claim errors can lead to denials: incorrect medical coding, missing prior authorizations, clearinghouse issues and more. Here are 7 of the most common reasons for claim errors: 1. Claim errors can be caused by missing and inaccurate data “The number one denial issue most providers encounter is eligibility,” says Rob Stucker, Senior Vice President at Experian Health. “These issues begin upstream from the claims process during registration or pre-registration when the patient information that’s collected is either inaccurate or incomplete. It may be as simple as a patient giving their name as Rob instead of Robert, or the registration staff selecting Medicaid as the payer, instead of Medicaid Managed Care. If the eligibility information is even slightly off, the claim will come back as denied.” Collecting accurate demographic and insurance information up-front using digital patient intake tools opens the digital front door and can help eliminate errors during the healthcare claims management process. 2. Manual processes and disparate systems Wherever claims processes are not automated, human error and delays can set in. In addition to typical random glitches and mistakes, many healthcare providers struggle with disparate systems from multiple vendors, in which the front-end and back-end do not communicate seamlessly. Using a single vendor with solutions that manage the entire claims processing cycle can provide holistic help. ClaimSource manages eligibility validation by repurposing Experian eligibility transactions that providers have already run at registration and editing them against the claim.  This process allows providers to double-check the eligibility of the claim before it gets submitted, at no additional cost. In addition, it also does extensive claim editing, submissions, reconciliations, and reporting. This solution creates prioritized workflows and provides access to a national library of documented government and commercial payer edits, as well as custom edits, to meet individual provider needs. 3. Changes in payer requirements can cause claims errors “Providers tell us that a major pain point is constantly changing payer rules,” says Stucker. “Providers are confident that their claims are good, but the payers’ adjudication rules may have changed without prior notice.” The problem here is exponential: voluminous changes multiplied by a range of communication channels (or faulty communication) multiplied again by a proliferation of payers and policies. Keeping pace with these changes is difficult without partner support. “We continuously monitor hundreds of thousands of payer website pages each night for updates,” says Stucker. “When a change is flagged, an analyst looks at it and decides whether it should be added as an edit. We update our huge global library of edits on a weekly or even daily basis. These edits enable ClaimSource and our pre-837 editor, Claim Scrubber to automatically review claims for errors using the most recent payer updates. 4. Prior authorizations Pre-authorizations present challenges at many levels. 8 in 10 providers saw prior authorization requirements increase during 2021. Providers must track changing requirements, obtain authorizations prior to treatment or claims submission, and complete claims that meet complex requirements. When prior authorization requirements aren’t met, appealing a denial can be complicated at best, and many times prove to be irreversible. According to Medical Group Management Association data, a simple denial takes a seasoned biller two to eight minutes to work, but a complicated denial involving prior authorization requirements can take up to an hour to work, largely thanks to time spent on hold. Ensuring claims are completed as required in the first place using a pre-authorization tool, in combination with a claims editor that validates against pre-authorizations, saves valuable time and stress. 5. Short staffing and new trainees Staff hours and expertise are both in short supply, as many providers struggle to retain experienced staff and bring new hires up to speed. Having an automated process with built-in review and analytics can help ensure that claims are completed accurately and quickly. A Council for Affordable Quality Healthcare study found automated claims take 25% less time to process than manual claims, boosting productivity and freeing staff up for the more human-intensive aspects of their work. However, the key is “accurate and user-friendly” automation. A claims vendor should be keeping edits up to date, submitting claims timely and accurately to the correct payer, keep organizations informed on the claim’s status throughout the adjudication process, retrieve electronic remit files, link them to the correct claims, and establish a denial workflow to automatically show denials. This should all be done in an extremely easy to use user interface or directly back into Patient Accounting/Practice Management Systems. If vendors aren’t doing this, then staff will just be working harder instead of smarter. 6. Slow response and follow-through can lead to claim errors  Although delays themselves don’t necessarily cause errors, they can make resolution difficult and time-consuming. Time is always an issue for providers as claims must be submitted in specific time frames from the date of service. Therefore, getting the claim created, processed through a claims vendor and submitted to the correct payer must be done efficiently, or timely filing deadlines are missed.  The same is true for identifying and re-working denials. Denial backlogs quickly become overwhelming, increasing the odds of items slipping through the cracks or re-submission/appeal deadlines being missed. Automating status updates with enhanced claim status monitoring can relieve time-strapped staff of having to contact payers manually for the latest information on claims to find out which ones are being paid or denied. Enhanced Claim Status submits automatic status requests based on each payer’s adjudication timeline from the date of claim submission, returning the payer’s proprietary responses weeks before the Electronic Remittance Advice or Explanation of Benefits are processed. This gives staff a huge head start on working denials. 7. Difficulty managing denials When errors cause claims to be denied, a response is critical. A denials workflow management solution can optimize follow-up by identifying claim denials, holds, suspensions, zero-pays, and prioritizing denials that need the fastest attention. Denial Workflow Manager also allows organizations to track root causes, which in turn can identify operational changes that can be made upstream, and reduce the denials from happening to being with. Automation is the future of effective claims management Claims management is becoming more complex and demanding, but the digital tools that automate and improve processes can help providers rise to the occasion. It’s now possible to capture and use accurate data, integrate systems and processes to work together, stay up to date on payer requirements, track claim status, and even manage denials efficiently with the help of technology. Learn more about other solutions that can help healthcare organizations with claims management.

New research from Deloitte reports that healthcare costs for the average American could jump from $1000 to $3000 per year by 2040, putting pressure on households that are already feeling financially squeezed. Concerns about healthcare bills could push patients to delay or even default on payments. With inflation on the rise, providers must find ways to create a compassionate financial experience for patients to maximize collections. That's where Patient Financial Clearance comes in. While inflation and economic pressures are systemic challenges, the impact is individual. This should galvanize healthcare providers to find out exactly how patients may be affected. Using that knowledge, providers can then tailor the financial journey to make it as straightforward as possible for patients to manage their healthcare bills, whatever their specific circumstances. With data on patients' ability and likelihood to pay, providers can tailor charity care checks and maximize collections by building a collections process with the patient at its heart. Create a compassionate collections experience with Patient Financial Clearance Improving patient collections starts with identifying patients that are unlikely to be able to pay and checking their eligibility for extra support. Traditionally, providers might use manual processes to calculate a patient's propensity to pay or entitlement to financial assistance. This might involve asking the patient to fill out a form with their financial details, calling the patient and the patient's employer multiple times to understand their income, manually checking their information against the Federal Poverty Level to see if it meets the threshold for full or partial charity support, and then having the patient fill out yet more forms. Such labor-intensive work is a drain on staff resources, and often a stressful experience for patients. Patient Financial Clearance helps create a more positive financial experience by automating eligibility checks. That way, patients can be assigned to the right payment pathway without delay. This solution also empowers patients with mobile text-based financial screening and provides them with updates on their charity status. It uses current financial data to screen patients to see if they're eligible for Medicaid, charity support or other financial assistance programs, prior to or at the point of service. Armed with this data, providers can offer the best possible support to these patients and even auto-enroll them in the right program. For those with medical bills, Patient Financial Clearance calculates an optimal payment plan based on how much the patient is likely to be able to afford, so patients are clear about what they'll owe and when. It can also suggest upfront fee collection when a patient can afford to pay but has been historically slow to do so. Personalizing the payment pathway with digital financial solutions Making sure patients don't miss out on financial assistance is just one way to use data and automation to personalize the payment process. Data-driven personalization should be a thread that runs through the entire financial experience, including: 1. Personalized upfront payment estimates Price transparency remains high on the agenda. Patients want to know their bills in advance so they can plan. Surprise bills lead to delays and frustration, to the detriment of both patients and providers. With Patient Payment Estimates, self-pay patients can generate personalized pre-service cost estimates so they can get their financial ducks in a row before treatment even begins. These estimates are based on the patient's individual insurance status, current payer rates and the provider's chargemaster data. The tool also incorporates any applicable financial assistance, applies prompt-pay discounts, and suggests convenient payment plans that fit the patient's individual circumstances. 2. Tailored payment plans for all Once the patient has their estimates, they'll want to know exactly when and how to pay. Some will be able to pay the full amount upfront, while others may need to spread out payments into more affordable chunks. Providers can maximize swift collections by ensuring that individual patients are directed toward the most appropriate option. Oftentimes, it may make sense to collect more payments upfront to alleviate collections costs downstream. One way to deliver this is through a self-service portal such as PatientSimple, which provides a one-stop-shop for patients to view their estimates, consider pricing plans and keep credit card details on file. Being able to plan in this way gives patients more control and avoids any confusion about payments. 3. Consumer-friendly payment methods When it's time to pay, patients want options. Not everyone wants to come into the office, send credit card details in the mail, or exchange details over the phone. Online payment portals, contactless payments and mobile wallets are increasingly popular. Therefore, providers need to offer convenient digital payment options to remain competitive.Offering a menu of payment options early in the patient journey means patients can “frontload” their financial admin, get payments out of the way, and focus on medical treatment. By giving patients control over how they pay, providers can reduce the risk of late and missed payments. 4. Timely and relevant communications If there's one action that can make or break a patient's perception of their financial experience, it's how their provider communicates with them. If information about medical billing is accurate, timely and compassionate, then the patient will feel more positively than if messages seem aggressive or contain errors. Getting this part right will improve patient engagement, drive faster patient collections and boost patient loyalty.Healthcare marketing data can be used to underpin a personalized communications strategy and help providers send the right message at the right time, based on the patient's preferences. When it comes to delivering the message, patient outreach solutions can send automated text and voice messages with bill reminders and links to payment methods to encourage prompt payments. Use Patient Financial Clearance to automate patient financial assistance Building a patient financial experience around the principles of personalization, empathy and convenience puts providers in a stronger position to maximize patient collections than with a one-size-fits-all approach. Find out how Patient Financial Clearance and other digital patient financial solutions leverage data and automation to identify and deliver what each patient needs, to improve patient satisfaction and increase the number of bills paid in full.