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The payer policy rollercoaster has taken a few twists and turns recently, leaving healthcare organizations out of the loop if they try to keep pace with payer requirements using manual systems alone. Keeping track of changing payer requirements has long been a major challenge for providers, but several shifts in the reimbursement landscape have prompted payers to implement updates at rates providers may struggle to match. More flexible policies permitted during the pandemic are being rolled back, altered employment patterns are influencing insurance plan administration, and new clinical delivery models (such as telehealth) are necessitating different coding structures. Healthcare providers that fail to keep up with these changes could end up wasting many hours and resources to rework claims. Instead, they should consider using automated payer alerts to ease the administrative burden, keep a lid on denial rates and protect profits. Automated payer alerts give providers the power of knowledge For many providers, staying on top of payer requirements involves recurring calendar reminders to check payer websites, subscribing to payer newsletters or social media accounts, or poring over industry media coverage for a hint at possible changes to come. If these checks were automated, providers could save hours of valuable staff time, and feel confident that no vital details are missed. With automated Payer Alerts, providers get instant access to the payer policy and procedure changes they’re too busy to catch. It’s a simple and convenient way to monitor modifications so claims can be submitted correctly the first time. This means staff can spend less time researching changes to procedures. Through an online portal and daily email digest, providers get timely alerts about payer changes posted on more than 120,000 different web pages. Every notification is the result of extensive behind-the-scenes work by Experian Health’s proprietary software. The program generates alerts with a detailed summary of changes, a link to the affected policy and a breakdown of changes by healthcare specialty. This allows providers to prioritize those that are most relevant to their organization. Client success story: Payer Alerts pay big dividends Being in the loop about what’s covered and what’s not puts providers in a better position to protect revenue by enabling more efficient allocation of resources, minimizing claim denials and avoiding missed revenue opportunities. New York-based University Physicians Network (UPN) implemented Payer Alerts to help physicians avoid denied claims. The CEO said, “Payers are increasing their edits, but if you know about them ahead of time and can make the required adjustments, you can avoid both denials and time-consuming appeals. With Experian Health, we now have an automated, straightforward process that helps us minimize unnecessary denials and take a proactive approach.” One UPN group recovered $42,000 as a result of a Payer Alert on a single policy change. Amplify results with the right healthcare payer solutions Payer Alerts helps healthcare organizations streamline their workflow and maximize revenue through more than just its immediate features. Its compatibility with other automated healthcare payer solutions can build the perfect defense against payer reimbursement challenges. For example, combining Payer Alerts with Contract Manager and Contract Analysis helps hospitals manage multiple payer contracts and checks that the correct amount has been reimbursed. Contract Manager allows providers to monitor payer performance and arms them with the data to negotiate more favorable contracts. It generates reports that support better communication with payers. This results in fewer phone calls to resolve issues and reduces the likelihood of misunderstandings over patient insurance status or whether a claim was received. Similarly, Claim Scrubber works alongside Payer Alerts to review every claim and verify that it’s coded correctly before being sent to the payer, to reduce the risk of denials. Claim Scrubber also now includes billing modifiers designed to support compliance with the Appropriate Use Criteria program. Using Payer Alerts to keep pace with regulatory changes Looking ahead, providers must continue to pay attention to legislative changes that affect payer strategies. Implementation of the No Surprises Act and related legislation should lead to greater transparency and more effective data sharing within the healthcare community. However, it also puts pressure on payer-provider relationships. Payer rules may continue to change, which means that payers may interpret these rules differently. Experian Health’s regulatory solutions can help providers stay on top of these changes and avoid penalties. Ultimately, providers can’t respond to changing payer policies if they don’t know those changes have been made. While change is inevitable, losing valuable time and revenue to inefficient manual processes is not. By investing in automated healthcare payer solutions, providers can adapt to change and stay ahead of the game. Find out more about how Experian Health’s Payer Alerts can help healthcare organizations capture the necessary information to make timely and strategic decisions to protect profits.

The Health Resources and Services Administration (HRSA) recently ended its COVID-19 Uninsured Program (UIP), meaning that providers can no longer seek reimbursement for COVID-19 testing, treatment and vaccine administration for uninsured patients. Evidence suggests that there could be new infections in the fall and winter, which means the need for testing and treatment has amplified. A $10 billion COVID-19 funding proposal that followed this program is also being held up in Congress, which means that it can take much longer before funding is provided. While this bill may eventually be approved, it is unlikely to include uninsured Americans. This means healthcare organizations must be extra vigilant to find missing insurance coverage for COVID-19 care. The challenge is broader than the end of the UIP program. Continuous Medicaid enrollment will also come to an end when the pandemic is no longer considered a public health emergency. Providers will need to resume eligibility and renewal checks, which will cause massive disruption as millions of individuals potentially lose coverage. In the face of reduced reimbursements, providers may have no choice but to turn away uninsured patients or absorb care costs themselves. But there is a third option – to check for missing and undisclosed coverage and maximize opportunities for reimbursement throughout the patient journey. This can be resource-intensive if not implemented strategically. It often requires a major investment of staff time and effort, which many organizations can hardly afford, as a result of staffing shortages and larger financial pressures. However, with the right data, automation and coverage discovery strategies, providers can maximize available reimbursements and minimize disruption, without eating up staff resources. Here are 4 strategies to find missing insurance coverage and increase reimbursement as COVID-19 funding ends: 1. Run continuous checks for missing coverage As churn increases gaps in coverage, providers must perform due diligence to find coverage for their patients. Many patients have forgotten or undisclosed coverage; however, tracking it down can be an administrative nightmare. It requires staff to run multiple checks of public programs and disparate payer networks, with no guarantee that coverage will be found. With such huge changes to the Medicaid landscape on the horizon, manual checks are not an option. Providers must find an efficient way to check coverage for patients who need COVID-19 testing and treatment, or for those who may be losing government coverage. Experian Health's Coverage Discovery uses advanced data analytics and automation to help providers locate hard-to-find coverage, without placing an undue burden on staff who are already under immense pressure. Coverage Discovery uses millions of data points and sophisticated confidence scoring to comb through government and commercial payer databases, eliminate write-offs and speed up reimbursement. It automatically runs checks before the patient comes in for care, at the point of care, and post-service. This ensures that if the patient's coverage status changes during their healthcare journey, potential reimbursement opportunities won't slip through the cracks. This solution helped identify previously unknown billable insurance coverage in more than 27.5% of self-pay accounts in 2021. 2. Verify coverage as early as possible Federal funding during the pandemic required states to expand Medicaid support, leading to an unprecedented 85 million enrollees. As emergency support winds down, state Medicaid agencies will have one year to check the eligibility of each individual and notify those who no longer qualify. With each check taking around two to three months to complete, agencies and providers will need robust workflows to maximize capacity and communicate with patients. A KFF survey in March 2022 found that only 27 out of 50 states had plans in place to address eligibility redeterminations and disenrollments once continuous enrollment ends. Access to reliable datasets and automated software can help providers confirm patient contact details and continue checking for coverage as patients transition from one plan to another. Should coverage be found, providers then need to verify that planned treatment or services are eligible for reimbursement and determine the patient’s financial responsibility. The sooner this can be done, the more likely it is that bills will be settled. Experian Health's Insurance Eligibility Verification solution can be part of the strategy to streamline eligibility checks and verify active coverage earlier in the billing process. This continuous, automated workflow uses real-time data to drive higher reimbursement rates so that providers can focus on providing the best care for their patients. 3. Get patients onto the right plan to increase rapid reimbursement In many cases, government and commercial coverage only cover a portion of a patient's medical bill. If more patients are responsible for a greater portion of costs – whether for COVID-19-related care or otherwise – there's a higher risk of delayed payments. Confusion over federal funding or changing Medicaid coverage could compound this. Providers can improve recovery rates by assessing a patient's ability to pay early in the process, and quickly steer them toward the right financial pathway. Patient Financial Clearance determines which patients are more likely to pay and connects others to payment plans and financial assistance programs, so collections teams know where to direct their resources. Not only does this improve workforce efficiency and avoid missed reimbursement opportunities, but it also means that fewer patients will have to miss out on necessary care because of ambiguity over how it will be funded. 4. Optimize collections to direct resources to the right accounts Another way for providers to protect their revenue once federal reimbursements end is to optimize the collections process. Collections Optimization Manager helps providers adopt a targeted collections strategy, to focus on accounts with the highest likelihood of being paid. Novant Health used Collections Optimization Manager to automate patient collections for a faster, more efficient and more compassionate collections experience. This collections technology allowed the team to tighten up patient segmentation, allocate staff resources more efficiently and keep a closer eye on agency performance, leading to a 6.5% recovery rate and a 5.8% increase in unit yield year-over-year. Learn more about how Experian Health's Coverage Discovery solution can help providers find missing insurance coverage and secure higher reimbursement rates as pandemic support programs come to an end.

Earlier this year, Experian Health teamed up with PYMNTS to ask more than 2300 consumers about their digital healthcare habits. The results confirmed that consumers are eager to use digital channels, but still experience challenges in finding options that meet their expectations. The Digital Healthcare Gap: Streamlining the Patient Journey examines how healthcare providers currently use digital tools to allow patients to book appointments, obtain test results and make payments. It also examines how providers are closing gaps. This article summarizes the key insights that will help providers create a seamless digital experience and improve patient engagement. Download the report to get the full study, and to learn how healthcare providers are using digital channels to improve care and drive engagement. How are healthcare providers using digital channels to streamline access to care? While most patients still prefer to interact with healthcare providers in person or by phone, digital methods are increasingly popular. For example, Experian and PYMNTS data show that: 1 in 5 patients used digital channels to schedule appointments within the previous year. 1 in 3 patients used patient portals to fill out registration forms. 1 in 4 patients used digital methods to pay for healthcare. Urgent care patients were the most likely to schedule appointments online, with 17% using patient portals, 16% scheduling directly through practice websites and 5% booking by text message. Patient portals were also the most popular digital channel among patients booking appointments with family practices. These insights suggest that patients want on-demand patient access and a range of options to book, register and pay for care in a way that’s most convenient for them. When they have that choice, many opt for digital methods, though results vary by type of provider. Patient portals are emerging as the most popular channel because they allow patients to securely access and manage their healthcare information in one place, whenever and wherever they like. Missed us at the MUSE Inspire Conference? Contact us for more conversations about opening healthcare’s digital front door. How can providers better engage patients using digital healthcare solutions? Despite their enthusiasm, many patients run into challenges when using patient portals, especially when making payments. Obtaining accurate cost estimates before coming in for care was a major pain point for 15% of patients surveyed. Portals are an obvious solution, but only 24% of patients said they had access to portals that include this feature. Even among those patients with access to “estimate-enabled” portals, only 6% said they knew their out-of-pocket costs in advance, which may point to communication or usability issues. The ability to receive cost estimates in advance of treatment has a major impact on how satisfied patients feel with their overall care experience. Nearly 85% of patients said they were satisfied with their care, but those who did not receive cost estimates for their most recent appointments tended to be less satisfied. The portion of urgent care patients satisfied with their experience dropped to 74% when out-of-pocket expenses weren’t known in advance. Experian Health’s Patient Estimates can help address these gaps. This web-based pricing tool gives patients accurate cost estimates before their treatment and offers advice for financial assistance and charity options. Patient Financial Advisor complements this by delivering pre-service estimates of the patient’s responsibility straight to their mobile devices. With this solution, patients get a text message with a secure link to their cost estimates and payment options. Providers that offer a convenient and transparent financial experience through these types of digital tools are likely to see improved patient engagement and more efficient patient collections. Tom Cox, President of Experian Health, says that digitally-enabled convenience is the secret to better patient engagement. “Patients are consumers before they are patients. They may not be experts in medicine, but when it comes to convenient and efficient scheduling, registration, estimates, payments, communication, and flexible delivery of these services, the consumer becomes the de facto expert. Healthcare is quickly approaching the point where a standard of convenience and ease of use – primarily delivered via digital tools ­– will result in patient attrition for those failing to meet the standard. The ’innovation’ needed is to reach parity with the experiences consumers have in their other service interactions.” “Healthcare is quickly approaching the point where a standard of convenience and ease of use – primarily delivered via digital tools ­– will result in patient attrition for those failing to meet the standard.” – Tom Cox, President at Experian Health How can digital healthcare solutions attract and retain new patients? The research also found that opening the digital front door can supercharge efforts to attract new patients. 3 in 10 patients use digital methods to find and select providers, with 1 in 10 using online reviews as part of their search. Nearly 2 in 10 struggle to find the professionals they need. Building a consistent online presence can help increase providers’ “discoverability” and signal a commitment to digital healthcare that so many patients desire. Providers that offer easy and reliable digital tools are also going to be more likely to attract and retain new patients. With 20% of patients saying portals are complicated to use, and 13% saying they lack functionality, providers that offer streamlined digital services are going to be more attractive. Building on the existing momentum with online self-scheduling and self-service patient registration can make it easier for patients to choose and register with new providers. Cox recognizes that digital solutions are not a simple fix – but worth the effort. “As consumers, we take something like scheduling for granted. What goes on behind the scenes is pretty complicated, however. In the case of scheduling a medical visit, there are specific time slots, physician schedules, how to address cancellations and the need for referrals, among many other variables…. It can be challenging for a healthcare provider to aggregate disparate data into a digital tool that’s easy for patients to engage with. That’s why solution partners like Experian Health are critical to help deliver a better patient experience.” Find out more about how Experian Health’s tried and tested digital tools can help providers streamline the patient journey.