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“Experian Health’s speed and ability to speak our business language definitely impressed us,” said ACS president, Tim Anderson. “Some of the claims were valid for only a few more weeks, and we were able to submit them in plenty of time. This is the best, fastest platform we’ve seen to reconcile duplicate and data-deficient records. It really helped us achieve the best possible resolution for our clients and our company.” Acadiana Computer Systems, Inc. (ACS) was contracted with numerous labs in Louisiana to submit billing claims, primarily to Medicare, for testing that occurred in the first months of the pandemic. Unfortunately, in the chaos and scramble to offer testing services as quickly as possible in nursing homes and testing sites, the labs struggled to collect needed information to submit valid claims – in particular the Medicare beneficiary’s MBI number, or even a Social Security number. As the pandemic response progressed, a similar challenge developed around the administration of vaccines, particularly in mass vaccination sites and other off-site vaccination centers. Providers struggled to get more than a name and maybe a birthdate, address, or phone number. This left a gap in ACS’ efforts to submit private insurance and Medicare reimbursement claims on behalf of their clients. ACS worked with Experian Health and our Universal Identity Manager (UIM) platform, delivering the Experian Single Best Record (ESBR) – the matching of records through aggregation of disparate information and delivering a single record that accurately identifies separate records that belong to one person. The platform uses multiple data sources to verify, match and consolidate disparate records into one “best record.” ACS assembled the records requiring more identifying data and prepared them for secure transfer to Experian Health. Experian Health securely accepted more than 75,000 patient records and ran them through the UIM platform in 24 hours. It was critical to assign an SSN to as many individual records as possible, and to confirm an associated MBI number for Medicare billing, if applicable. Results included: 69% assigned unique records 12% identified as duplicate records With the information delivered back from the matched records, ACS had all the necessary data needed to continue the billing process. Within a week claims were submitted, expected to exceed $20 million in collections when the process is completed. The ACS group was experienced, savvy and data ready. Their expertise enabled an elegant and efficient exchange and complemented Experian Health’s capabilities. ACS expects to continue to use Experian Health’s UIM platform throughout the pandemic and also for mitigating duplicate records and preparing claims for submission. Learn more about how our Universal Identity Manager (UIM) platform can help your organization eliminate duplicate patient records.

  “The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. It has been a mess.”   This is what one healthcare executive told us when we surveyed patients and providers on the state of patient access, in June 2021. Changing prior authorizations requirements were particularly messy, and as more patients return to care, there’s a risk they’ll become even more chaotic.   During 2020, many in-person healthcare services were canceled, delayed, or avoided for fear of infection. Now, patients feel more comfortable about returning for care. When we first surveyed consumers in November 2020, 58% said they’d wait until COVID-19 subsides before rescheduling. In June 2021, only 19% said they’d wait. Canceled procedures have dropped by half, and while the opportunity to recoup lost revenue is a relief for providers, processing prior authorizations for the sudden influx of patients is a worry.   Two thirds of providers say they find it difficult to keep track of changing pre-authorization requirements. Two in three also expect to face issues in securing authorizations for scheduled elective procedures, up from just over half last year. Embedding accurate and efficient workflows will be paramount as patient volumes rise, which means it’s time to rethink the archaic manual processes that often result in delays, errors, and non-compliance. Could automation offer a mess-free way to manage the growing challenge of prior authorizations?   Manually managed prior authorizations cost time, money, and quality of care   Even before the pandemic, prior authorizations were a thorny issue for healthcare organizations who wanted to offer the best possible care to patients, without risking denied claims. According to the Medical Group Management Association (MGMA), 80%-90% of medical groups say prior authorization requirements have grown year over year.   In an ideal world, prior authorizations protect patients from undergoing therapies that are overpriced, ineffective or unnecessary. They assure providers that they’ll be reimbursed for the services they deliver, and confirm that treatments are high-quality, evidence-based, and safe.   In reality, while prior authorizations can help incentivize value-based care, the admin and financial burden for providers is growing exponentially. Frequent changes, increasing denials, and lengthy negotiations with payers mean many providers need to employ additional full-time staff to handle prior authorizations. As the cost of drugs soars, they’re forced to lay out huge sums and cross their fingers as they wait to recoup the costs.   There was a hint of respite at the peak of the pandemic, when payers lifted many requirements, or extended authorizations already held on file. But these changes took time to filter through, and some providers continued to lose up to two entire business days per week to prior authorizations work during the pandemic.   Now, as the pandemic starts to settle, those requirements are back (and growing), and providers are scrambling to re-join the dots using their old, manual processes. As patient numbers surge, traditional manual methods for such an admin-heavy process are straining under the pressure. With so many accounts to authorize, the need for an automated solution is even more apparent.   Leveraging automated solutions for speedy, accurate prior authorizations To ensure patients get the care they need and to keep a lid on further revenue loss, hospitals and medical groups should consider tapping into automated authorizations engines. With an integrated Authorizations management system, you can initiate more authorizations in less time, run automated status checks to avoid rescheduling care, keep abreast of changing payer rules, and avoid unnecessary reworking of claims.   Users are guided through the workflow, which auto-fills essential real-time payer information. Patient information is populated by the SmartAgent feature, so pre-certification can be progressed quickly behind the scenes. Users only need to step in when clinical questions pop up. Notice of Care (NOC) generates a worklist of all pending patient encounters, to ensure that no payer notification requirements for notice of admission, observation or discharge are missed. Staff can escape the time-suck of repeatedly checking payer websites or calling up payers to verify yet again whether a patient encounter qualifies.   Say goodbye to Excel spreadsheets and lengthy calls to payers For organizations worried about rising patient numbers choking their existing manual workflows, switching to an automated system could be a timely move. Chasing paperwork is never a good use of resources, and with the lingering possibility of pandemic flare-ups, automated authorization inquiries could help minimize time spent on tedious manual tasks and running checks with payers.   Find out more about how Experian Health’s Prior Authorization software could help your organization minimize the risk of missed reimbursements, and give your team the breathing space needed to focus on maximizing support for patients returning to care.

More than 40% of patients surveyed skipped medical care in the early months of the pandemic, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health. Of those who needed care, 58% missed scheduled preventive care. Similar trends are observed in cancer screening, with appointments for breast, colorectal, and cervical cancers – in some cases dropping by around 80%-90% in March and April 2020, compared to 2019. Diagnostic testing for several cancers also plummeted, as did HPV vaccinations.   These trends aren’t unexpected: COVID-19 forced medical facilities to cancel or scale back services, while fear of infection and financial worries kept many patients away. But with most services operating at near-normal capacity again, and the vaccine program tipping the balance in favor of rescheduling care, preventative services are still lagging. Many patients remain reluctant to attend screening and wellness visits, despite the health risks associated with delaying care for potentially serious conditions.   Re-establishing a preventive care routine is essential. For patients, getting back on track with earlier diagnosis means more timely treatment and a better chance of recovery. It promises a better financial outlook for patients, payers, and providers alike, who all suffer higher costs when medical conditions escalate. And providers want to get their day-to-day business back on track to smooth out what has been a heavily disrupted workflow and revenue cycle over the last year.   Providers must reassure patients that returning to care is safe and necessary. Compassionate and personalized support will be key to making sure patients get the right care at the right time. Automated patient outreach strategies built on comprehensive patient data can help reverse the trends in forgone care.   How can data and automation support personalized patient outreach?   Kelly E. Anderson, one of the authors of the John Hopkins study, suggests that “physicians can mitigate some of the long-term harmful effects of this forgone care by proactively reaching out to patients who missed care, to try and reschedule the care either in-person or through telehealth.”   Automated outreach combined with easy patient scheduling platforms can help providers identify and invite healthcare consumers to get much-needed preventive care appointments back on track. For example:   Automation makes scheduling easy for patients and efficient for providers Online scheduling platforms allow patients to reschedule missed appointments at a time and place that suits them. A targeted outreach list of those patients most likely to need screening (for example, based on age, lifestyle, or health risk factors) can be used to send automated booking prompts and reminders by text message or interactive voice response (IVR). It’s simple and convenient for patients and reduces pressure on call center staff. Plus, it generates a wealth of useful real-time data on response rates to pinpoint areas for improvement.   With the right data, providers can direct patients to appropriate services For patients that can’t or prefer not to attend their usual healthcare facilities, directing them to telehealth services or alternative venues might be a good option. Similarly, patients with a medical or family history that suggests a higher risk of cancer ought to be prioritized for screening. But you can only do this when you know who those patients are, and what exactly they need. Social determinants of health can be a powerful tool to help providers determine a holistic view of patients’ clinical and non-clinical needs.   ConsumerView collates consumer data from over 300 million individuals, across multiple demographic, psychographic and behavioral attributes, so providers know more about the lifestyles and interests to be able to effectively resonate and engage. Data helps create a better patient financial experience Since many patients are worried about the loss of health insurance, outreach efforts might also involve pointing patients towards appropriate financial support. When socio-economic data reveals that a patient is struggling financially, providers can quickly check for missing coverage, offer tailored payment plans, and help obtain charity care if required.   Automated outreach can also deliver the upfront information about healthcare pricing that so many patients demand, and help staff collect faster patient payments by providing easy payment links through text and IVR campaigns. Consumer data can inform compassionate patient communications With the majority of patients opting out of scheduled appointments because of concerns about COVID-19 exposure, any invitation to reschedule care should offer plenty of reassurance about hygiene protocols. Some patients may need a gentle nudge to reschedule appointments, so if you can help them feel comfortable visiting facilities and tell them what to expect, they’ll be more likely to return.   Offering additional reassurance and support to communities who are traditionally underserved by healthcare services, or who have been harder hit by COVID-19, will be even more important. Best contact information, social determinants of health insight and ethnicity insight can support efforts to promote screening to groups who may face additional barriers to care.   With the right data, you can go beyond compassionate messages and choose an appropriate communications channel that’s the right fit for the consumer, too.   One thing that hasn’t been hindered by COVID-19 is the trend toward healthcare consumerism. Patients have a choice about which provider they use. Proactively supporting patients to catch up on missed care is a surefire way for providers to stand out as the easy choice.