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The COVID-19 pandemic has highlighted the need for a more responsive, flexible and resilient approach to revenue cycle management, underscored by provider staffing shortages across the country. Automation is gaining momentum as a way to address the staffing issue while improving efficiency and collections optimization to levels better than those prior to the pandemic. Furthermore, with the No Surprises Act effective as of January 1. 2022, automation and digital tools can help providers deliver transparent pricing with real-time cost estimates. With automated healthcare collections, providers can help patients plan for their healthcare costs. This is especially important, given that half of Americans currently have unpaid medical bills. In North Carolina, Novant Health is already seeing an impressive return on their investment in automated patient collections technology. The provider logged over 5.8 million medical encounters in 2020. Novant Health’s patient finance team wanted to address growth while continuing to deliver an improved patient financial experience. They wanted to automate workflows and processes to reduce the need for staff intervention, using a wide-ranging platform that would easily integrate with Epic and provide robust reporting and insights. Compiling agency performance reports for 21 agencies each month was another cumbersome task, so the team also wanted a partner who would help elevate and monitor agency performance. Watch our webinar with Novant Health to see how they used Collections Optimization Manager to increase patient collections and create better patient financial experiences. Delivering a “human experience” with the right patient collections partner Wendi Bennett, Director of Patient Finance at Novant Health, said it was important for them to find a strategic and collaborative partner who would understand their commitment to providing a remarkable patient experience: “The patient can have a wonderful clinical experience but face a financial experience that falls short of expectations," said Bennett. "We wanted a dedicated consultant who would recommend best practices and provide valuable industry insights, and a system with proven results in back-end automation, operational improvement and analytical performance. We were looking to propel our patient experience to the next level and that’s why we partnered with Experian Health.” Automated healthcare collections insights for a better patient experience and fewer unpaid medical bills Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, is the Collections Consultant who has been working with Wendi’s team to implement the Collections Optimization Manager. Cari explains how the Collections Optimization bundle delivers the data insights and execution support that Wendi and her team were looking for: “We’re able to extract data from the facility’s accounts receivable file and produce robust analytics and insights. That allows us to screen or scrub out those accounts that we should not be scoring or segmenting. Then, we shift to the customized segmentation which provides the client the ability to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.  Customized segmentation also gives the client the ability to keep the best, most collectible accounts in-house longer and give the lower yield accounts to their early out agency sooner. We drive revenue back in the door by focusing on these accounts. Finally, we monitor for new insights into patients’ propensity to pay. And with Collections Optimization Manager, our clients receive consultant support as part of the bundle, who provide best practices, insights and analysis throughout the relationship.” Highly predictive patient segmentation means that Novant Health knows which patients are most able to pay, those eligible for charitable support, and who should be directed to different payment plans. This supports more compassionate financial conversations and communications with patients. It also creates opportunities for personalized recommendations, such as reminding new parents to ensure their child is included on their healthcare insurance. The more transparency, simplicity and compassion that can be built-in, the easier the process will be for patients. For providers like Novant Health, that means fewer bills being written off. Efficient allocation of patient collections staff resources Collections Optimization Manager also allows providers like Novant Health to focus their efforts on the right accounts. It doesn’t make sense for staff to spend valuable time following up with patients who have a low co-pay amount and a high likelihood to pay. Simple automated reminders address that situation. The Novant Health team used automated dialer campaigns to reduce manual outbound calls and allocated limited staff resources to more complex accounts. A split-screen shows staff all the information they need during the call, eliminating the need to log into multiple systems at once. Call recordings stop automatically before the patient shares their credit card information, ensuring PCI compliance without extra steps. Keeping track of collections agency performance – and costs With Collections Optimization Manager, Novant Health can prioritize high propensity-to-pay accounts in-house, which helps to manage agency costs. A customized scorecard and dashboard keep track of agency benchmarks, giving the executive leadership team a real-time snapshot of performance, informing decisions about vendor management. The Compliance Manager function helps Novant Health ensure agency collections have compliance at top of mind and are not solely focused on the highest yield accounts. This function, combined with better segmentation and a higher call connection rate, results in higher recovery rates. With Collections Optimization Manager, Novant Health has seen a 5.8% increase in unit yield year-over-year, and an overall recovery rate of 6.5%. Overall increased revenue and cost savings amount to an impressive rolling average return on investment – 8.5:1. Watch the webinar to find out more about how Novant Health boosted its patient collections recovery rates with an automated healthcare collections platform. Find out more about how Collections Optimization Manager can help your organization use automation and digital tools to create a more efficient patient collections process and a more streamlined patient financial experience.

Claims denials are a major source of headaches for healthcare organizations. On average, denied claims can take more than two weeks longer to pay out than first-time claims, if they get paid at all. Denials can have major downstream impacts, including lower annual net revenue, additional hours spent on administrative work, and potential disruptions to patient care. Claims denials aren’t just an occasional inconvenience, either. A recent American Hospital Association (AHA) survey found that 89% of all hospitals and health systems have seen a rise in denials over the past three years, with half of the participants describing the increase as “significant.” Data from Healthcare.gov confirms this trend. The Kaiser Family Foundation (KFF) states that in 2019, health plans available on the individual market denied an average of 17% of all claims – up from 14% the year before. It’s becoming more critical than ever for healthcare organizations to employ integrated, intuitive, and technology-driven strategies to get their claims paid in a timely and efficient manner. Reduce claim denials by eliminating administrative errors and manual processes Health plans can deny claims for any number of reasons. The good news is that in 2019, KFF found that less than 1% of claims were denied based on medical necessity. The bad news is that the remaining 99% were denied largely due to other reasons. This included referrals, prior authorizations, coverage disputes, data errors, and clearinghouse problems. Many claims denial issues occur when organizations rely on manual processing of complex documents that are subject to ever-changing requirements from a wide variety of payers. Mistakes are not uncommon, and that ends up costing time and money. Smart, intuitive claims management workflows that take advantage of automation technology can augment staff resources and reduce the likelihood of errors. Automation contributes to clean and accurate claims the first time around. According to the Council for Affordable Quality Healthcare (CAQH), manual processing can take an average of four minutes per claim. Automation cuts this time by 25%, bringing the total time per claim down to just three minutes. This might not seem like a lot in isolation; however, it becomes more material when the time savings is applied to a large, multi-hospital health system that partnered with Experian Health to revamp its claims processes. The health system gets through 200,000 claims per month. That could translate into 200,000 minutes saved – or more than 3,300 hours – every 30 days. Amidst the staffing shortages that are persistent in healthcare, those numbers are significant. For providers of all sizes, the right automation tools use an expansive library of national payer edits, supplemented by custom edits, to ensure that claims are clean before they get out the door. These tools can also organize and prioritize accounts to help staff members use their time most efficiently. If a claim does have an issue, organizations can use additional technologies to stay one step ahead of the denials process. Enhanced claim status monitoring can give providers insight into potential problems long before the ERA and Explanation of Benefits are processed. This allows organizations to address known issues and predict their revenue cycle outcomes earlier and more accurately. Automation can also help providers slash even more time off the claims management process. The Council for Affordable Quality Healthcare (CAQH) estimates that it takes between 14 and 30 minutes to complete a manual claims status inquiry. Automated status monitoring can potentially shave 9 minutes off this task, freeing up staff to complete other tasks. There’s still plenty of options when claims do get denied. Providers can complement their claims capabilities with denials workflow management tools that can generate customized worklists, highlight ANSI reason codes and payer proprietary codes, and identify payer-specific denial trends to help inform decision-making. Automation creates a faster, more accurate claims processing ecosystem Most healthcare organizations use a number of different technologies to manage their revenue cycles, and all these systems must work together in harmony. Unfortunately, interoperability across disparate clinical and financial systems isn’t easy to achieve. In the case of the provider that chose Experian Health to improve its claims process, integration with Epic, its medical records system of choice, was very important. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, and found and repaired issues with the system build, creating opportunities for cross-training and centralized reporting. Thanks to this automated, integrated process, this provider improved its acceptance rate by 10 percent, consistently seeing 99 percent of its claims accepted. Additionally, its clean, paid claims percentage increased by over 10 percent, creating a more predictable, profitable revenue cycle. With denials on the rise in an increasingly challenging claims management environment, providers will benefit from replacing manual processes wherever possible.  Automation is the key to optimizing staff resources and significantly reducing reimbursement obstacles. To see sustained success with your revenue cycle, get in touch with Experian Health and start automating your claims process today.

As patient expectations shift, providers that offer a personalized healthcare marketing experience will be more likely to attract and retain satisfied consumers. The pandemic accelerated this shift. As a result, the traditional ways of healthcare marketing are starting to fall short. For example: A healthcare marketing strategy that’s designed for an “average consumer” results in a one-size-fits-all model that doesn’t always meet a patient’s individual needs. Communication options with fixed hours and channels don’t reflect “patient first.” Outreach messages blasted to an entire patient email list miss the mark for individuals who don’t speak the language or might prefer a quick text message instead. A study by Dassault Systèmes and CITE Research found that 83% of consumers expect products and services to be personalized within moments or hours. They’re accustomed to the “one-click” digital retail experience, which offers instant access to relevant recommendations and flexibility about how and when to buy. They’re also suffering from information overload, thanks to the sheer volume of emails, messages, articles and videos flooding their digital devices. Personalized communications can remedy that and help consumers feel respected and empowered, which drives connection and loyalty. But personalization isn’t just important for patient outreach. Personalized healthcare marketing can also help ensure patients get the treatment they need, by anticipating individual needs and highlighting relevant services at the right time. With the COVID-19 pandemic continuing to influence access to care, personalized healthcare communications can also be tailored for different patient segments. This can help reassure or remind individuals to book vaccination appointments or reschedule deferred care. Improve patient engagement with personalized outreach As digital offerings grow, consumer engagement expectations evolve. Providers must keep pace and communicate accordingly. Incorporating information about patients’ lifestyles, behaviors and preferences enables providers to deliver the right message at the right time. It also helps providers select and use the most effective channel of communication. Patients are more likely to respond and are empowered to manage their healthcare journey. For example, a Gen Z patient may prefer to receive appointment reminders by text, while an older patient may prefer a physical letter. One patient may prefer to get prescriptions mailed to their home while they’re at work, while another may be content to visit a pharmacy and pick up their medication while shopping nearby. Some patients will want a text message with a payment link to clear outstanding bills immediately, while others will appreciate a customized payment plan. Experian Health’s State of Patient Access survey 2.0 found that patients welcome proactive outreach by providers, though many say this doesn’t happen. Providers recognize the value in proactive patient engagement, but many say they lack the data to reach out effectively. With reliable consumer data and analytics, providers can create holistic profiles and deliver improved marketing to better serve new and existing patients. ConsumerViewSM pools data points on core demographics, behavioral insights, psychographic information and financial data to help providers understand their patients. This data can then be analyzed using Mosaic® USA and TrueTouchSM to segment, identify and reach the target audience with the most relevant message and format, and adapt based on consumer response. ConsumerView also adheres to consumer data privacy regulations, so providers can actively engage patients and build patient loyalty while confident in the knowledge that they have permission to use the data. Reduce readmissions and improve patient outcomes with better segmentation Personalized healthcare marketing isn’t just about messaging and channels. Providers that have a holistic picture of a patient’s lifestyle, life events, geographic changes and socio-economic challenges will be in a stronger position to anticipate their evolving wants and needs. For example, social determinants of health (SDOH) data can tell providers which patients may need extra assistance when visiting a doctor’s office, so that appropriate measures can be put in place. They might help identify patients with potential comorbidities that warrant proactive reminders about preventive check-ups. Similarly, providers can segment patients according to their financial situation. This can help with creating custom payment plans and sending timely payment reminders through targeted communications channels. Effective post-admission engagement can also help patients access the support needed to adhere to care plans, thus minimizing the risk of readmission and reducing unnecessary costs. A McKinsey & Co study found that around a third of patients with unplanned, high-cost follow-up care reported reasons that were considered avoidable, such as receiving unclear post-discharge instructions. Boost retention and recruitment with patient-centric and personalized healthcare marketing As rising medical costs and pandemic-related lifestyle shifts prompt more patients to shop around for care, providers must take action to create a healthcare experience that’s truly patient-centric. With data-driven healthcare marketing tools, providers can differentiate their services from other health systems vying for the same market. Find out how Experian Health can help your organization use consumer insights to build a patient-focused, personalized health marketing strategy to attract and retain satisfied consumers.