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Experian Health works with many of the largest, most sophisticated collections teams in healthcare that consistently strive for high-performance by innovating and adopting best practices. Our consultants are often asked to define “high-performance”. What separates high-performing collections teams from the rest and how do they impact the bottom line? Being a leader in data and analytics, we used our expertise to conduct an in-depth analysis to answer these questions, quantify the impact of high-performance, and identify best practices common to high-performing collections teams. Here is what we learned: 1. Spend time collecting on the right accounts Many health systems have developed collections workflows by segmenting self-pay accounts into varying buckets depending on the propensity to pay. However, not all segmentation models are created equal and ultimately a model is only as good as the data driving the decisions. Segmentation models are supposed to identify high and low propensity-to-pay accounts so that resources can be focused on collecting from accounts likely to yield revenue, building out custom workflows when possible. In fact, in a head-to-head comparison, a health system using a segmentation model based solely on patient payment history significantly underperformed a health system using a comprehensive, multifaceted segmentation model built using our Collections Optimization Manager. Here are the results: $60,000 in additional revenue generated from accounts in low payment likelihood segments 25% higher recovery rate in highest payment likelihood segments 100 more accounts worked in low payment likelihood segments Multi-faceted segmentation models increase recovery rate an average of 76% for the highest payment likelihood segments Using patient payment history within a single health system forces a decision to be made based on limited information. This leads to more time being spent on accounts that yield little to no revenue. Patient financial situations change rapidly and being able to see additional factors such as credit payment history, household income, and financial stress signals improves the ability to assess propensity-to-pay. This is particularly important for both new patients and those that visit infrequently. Utilizing a comprehensive segmentation model enables collections from the accounts and increases recovery rates for segments with a high propensity-to-pay. 2. Use automated dialing Imagine a world in which every collections call reaches the intended recipient. When comprehensive segmentation models are used in tandem with automated dialing technology, like Experian Health’s PatientDial product, the hypothetical can turn into reality. High-performing teams take output from their comprehensive segmentation models and use it to focus call center activity. The logic is simple; more contact attempts are made to reach accounts likely to pay and fewer attempts are made for low yield segments. For example, if a health system with 100,000 new monthly accounts uses a data-driven call strategy, call volume can be reduced by up to 20,000 calls per month. The highest-performing teams go a step further by pre-loading call lists into agent software and only allowing agents to join calls that successfully connect. This is where the real magic happens – valuable time is saved, and agents actually connect with more patients, ultimately increasing collections success. 3. Monitor agency performance It is no secret that some agencies perform better than others. In fact, even a trusted agency’s performance can vary over time as portfolios are rotated between different collection teams. So, what do high-performing collections teams do to influence consistent agency results? They use robust reporting to monitor and track agency performance over time. This helps direct account allocation decisions in a way that impacts the bottom line. It is Monitoring agency performance gives revenue cycle leaders the information needed to make better portfolio allocation decisions. Another benefit of monitoring agency performance is that agencies perform better just knowing they are being monitored, per an Experian Health analysis of agency performance across similar portfolios. Here are the key metrics: Monitoring agency performance enables better account allocation decisions, pushes agency partners to perform at a higher level, and significantly increases collections. 4. Reduce bad debt through presumptive charity Best-in-class providers automate the financial assistance process for low-income self-pay individuals. This has a significant impact on both patient and provider. Patients no longer receive statements or calls for an outstanding debt that they are unable to pay, and providers are able to save on variable expenses, such as statement and call costs, in addition to staff time spent manually inputting and verifying financial assistance applications. Automating the charity award process enables health systems to reduce bad debt expense, regardless of when awards are granted. In a comparison between health systems using an automated financial assistance process and a similar portfolio of health systems without automated financial assistance, we discovered that automation could reduce bad debt expense by as much as 10-12% on a similar demographic mix of consumers. [1] 5. Identify accounts that require special handling One of the most common mistakes that collections teams make is dedicating time and resources to accounts that are unlikely to yield revenue. Deceased or bankrupt accounts make up anywhere between 1 percent to 2 percent of self-pay portfolios. This means that for a monthly portfolio of 100,000 accounts, collections teams are unnecessarily calling or mailing statements for up to 2,000 accounts that require special handling and might produce no results at all. High-performing collections teams have automated processes in place to identify these accounts and either remove them from the AR file completely or place them with a specialty vendor as soon as possible. High-performing teams also focus on identifying and resolving incorrect patient addresses. Although mailing patient statements is a key part of nearly every collections workflow, undeliverable mail often remains unworked. Since accounts are less likely to yield revenue over time, it is imperative to identify and resolve address discrepancies quickly. Returned mail typically impacts 1 percent to 4 percent of a self-pay portfolio. This means in a situation with 100,000 new accounts each month, an additional $30,000 can be recovered using an automated process to identify and update undeliverable addresses. Interested in learning more? For more information on our healthcare collections products, click here.    [1] Data Study Methodology: In June of 2021, Experian Health performed an analysis on a nationwide sample of health systems to define industry best practices and quantify their impact.

The No Surprises Act, effective Jan. 1, 2022, requires that healthcare providers include a “Good Faith Estimate” that covers all relevant codes and charges. This was established to increase price transparency for patients. For a summary of the No Surprises Act, read our previous blog. In our recent webinar, hosted on December 15, 2021, industry expert Stanley Nachimson, principal of Nachimson Advisors*, answered our audience’s most pressing questions about “Good Faith Estimates.”** To read the FAQs from our first webinar, click here. Experian Health can help your healthcare organization navigate the regulatory landscape  and implement solutions ranging from transparent, patient-friendly estimates to our all-new FREE No Surprises Act (NSA) Payer Alerts Portal.  Here’s what Nachimson had to say: Q1: What are the top things to do now to prepare for the No Surprises Act by Jan. 1? SN: Set up processes to avoid out-of-network billing for emergency and in-network facility services Out-of-network providers need to make sure they have the right processes set up to avoid surprise billing patients. Evaluate in-and-out of network status for all providers Implement Good Faith Estimate for Uninsured/Self Pay from a single provider Make sure to have a process in place for self-pay or uninsured patients Prepare patient notice documents Train staff and ensure they’re aware of new rules and changes Q2: What must be included in the Good Faith Estimate starting 1/1/22? SN: Starting Jan 1, 2022, the only Good Faith Estimates required are for “self-pay” or uninsured patients. These are the only ones that will be enforced/mandated on January 1st. CMS has created forms that show what GFEs should include. This includes individual services that will be provided in an encounter, line-item descriptions of services, procedure codes, diagnosis codes, and more. Estimates should be within $400 of the final bill for any provider or facility that was included, assuming there are no extenuating circumstances. Q3: How should providers deliver the Good Faith Estimate to the patient? Payers? SN: For patients, Good Faith Estimates should be delivered in a written document. This can be done through email, USPS, or delivered in person. Currently, providers do not need to worry about sending anything to payers. Regulators put this requirement on indefinite hold until they have more clarity on the technical delivery/transition of this data. CMS expects to provide a ruling clarification on this in 2022. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. Q4: What are the differences between Insured & Self-Pay Good Faith Estimates that providers should consider starting Jan. 1? SN: There will probably be no significant difference in the GFEs for self-pay vs insured individuals. However, the GFEs will be sent to health plans for the insured individuals. At this point, there is no standard electronic delivery method. Individual providers/organizations may come up with their own paper or electronic form, assuming it contains all the required information. At some point in the future, the GFEs will be sent to health plans for insured patients, and that will most likely be a standard transaction. CMS is currently waiting on guidelines for what this transaction will look like. Q5: How does an estimate get calculated when there are multiple providers involved? Who is the “convening provider?” SN: A convening provider is the provider that (1) is responsible for scheduling the primary item or service(defined as “the initial reason for the visit”), or (2) receives a request from an individual shopping for an item or service)—must determine at the time an item or service is scheduled or when a patient is shopping for care whether the patient is a self-pay patient, as defined above. This will not be enforced on Jan. 1, 2022. In 2022, each provider will be expected to provide the GFE for their own services. Because there aren’t any processes in place, the healthcare industry will have at least 1 year to develop a standard guideline for gathering this information. The requirement that the convening provider combines all provider GFEs into one GFE will not be enforced until 2023.This means that over the course of 2022, the convening provider will not be required to include estimates from other providers.  The industry will need to create a standard guideline and establish communication processes first. Until then, patients will need to ask every provider involved for a Good Faith Estimate.  Providers may wish to consider how they will accomplish this during 2022. Q6: Does the Good Faith Estimate apply to all services – even office visits? Labs? Urgent care? Drop-ins? SN: It applies to all types of services. However, depending on when the service is scheduled, the timeframe will vary on when the Good Faith Estimate can be sent out. Q7: If the actual charges are more than $400 greater than the Good Faith Estimate, what consequences will be there for providers starting Jan. 1? SN: The latest rule established an independent dispute resolution process.  The patient must initiate the process within 120 days of receiving the bill, file the required documentation and pay a $25 administrative fee. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of December 23, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey – including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.  

The recent discovery of the Omicron variant has placed the world on high alert. As COVID-19 continues to transform and evolve, erupting as “new” pandemics within the existing pandemic,  it is becoming clear that digitally-enabled clinical care and access to that care are some of the world’s tools to mitigate its spread. Should infection rates rise, providers can anticipate fluctuations in patient volumes, which may trigger a return to the scheduling complexities seen earlier in the pandemic. Streamlining patient access with digital scheduling to minimize wait times, free up hospital beds, and ensure efficient intake workflows is going to be crucial. New variants could also exacerbate existing healthcare staffing shortages, which is a major concern for providers whose capacity is already at a “tipping point.” With a winter flu season “twindemic” looming on the horizon, and more people traveling over the holidays, this challenge may only get tougher. One route through this uncertainty is to continue the digital pivot seen in the early days of the pandemic. Here, we look at how flexible self-scheduling tools and other digital services can continue to help providers maintain operational efficiency as they navigate the implications of this new coronavirus strain. Uncertainty about Omicron – and future variants –  could trigger patient scheduling complexities The new variant could trigger a rise in patient numbers, as seen with the Delta variant. In parallel, some providers and states may follow New York’s lead to try to manage non-urgent care and postpone certain elective treatments. Patients, too, may decide to hold off on booking appointments if they’re worried about contracting the virus while visiting their doctor. This means that the scheduling (and rescheduling) challenges seen throughout the pandemic could resurface. Providers should be ready to offer easy and convenient self-scheduling options. Digital patient scheduling platforms allow patients to book essential care and reschedule deferred appointments from the comfort of their own home, using whatever channel suits them best. Not only will this ease pressure on busy staff and reduce the number of people sitting side-by-side in doctors’ waiting rooms, but it’s also a quicker and more reliable way for patients to plan their care. Providers can augment these operational efficiencies with digital scheduling and registration tools. Registration Accelerator can reduce the burden on patient access teams by allowing patients to create user profiles and fill out pre-treatment information from home. Double down on convenient vaccination scheduling New variant outbreaks also add a layer of urgency and complexity to the ongoing vaccination program. Boosting the country’s vaccination rates is a crucial defense against existing strains of COVID-19. Patient-friendly digital scheduling tools can make it as easy as possible for people to arrange an appointment, thus helping to bump up vaccination rates. Of course, if more people are encouraged to seek vaccinations and boosters, the scheduling process could get even more complicated. Again, digital self-scheduling tools can ease the pressure, by using real-time databases and automation to ensure that patients book appointments within the requisite vaccination window. Automation can also be used to deliver personalized patient outreach reminders, nudging patients to schedule their vaccine appointment if they haven’t made one already. Comprehensive consumer data can help identify the most appropriate messages and channels for different patients, to make it as easy as possible for them to plan and book their appointment. The federal response to new outbreaks has included provisions for vaccine outreach campaigns and education initiatives. Providers should consider how their own outreach campaigns are performing, as well as ensure that their scheduling platforms are ready to meet the increase in demand that’s likely to follow. Automation and digital scheduling tools could help alleviate staffing shortages Behind the scenes, providers are still wrangling with ongoing staffing shortages. According to an analysis of US Bureau of Labor Statistics data, hospital employment declined by nearly 100,000 between February 2020 and September 2021, amounting to a financial cost of around $24 billion. New variants could make this worse. If more staff are infected, healthcare organizations may find it more difficult to handle the increase in patient volume. Automating manual tasks can free up capacity by helping to manage the growing demand for services and reduce call volumes. These automated tools and systems are designed to be user-friendly for busy staff, and for patients looking for a stress-free patient access experience. With streamlined self-scheduling options and more efficient staff workflows, providers can feel more prepared in the face of uncertainty. Contact Experian Health to find out more about how digital scheduling tools can help your organization prepare as the Omicron situation unfolds.