Claims & Contract Management

In its first year of consideration, Experian Health’s ClaimSource® solution garnered the 2017 Category Leader title for claims management. This was achieved by having products and customer support that address the top issues in Patient Accounting, including: Declining reimbursement making it more important to ensure accurate payments Slow payment from third-party payers Having to make analytics-based key financial and operational decisions Constantly changing governmental mandates and payer requirements Managing the move from fee-for-service reimbursement to value-based reimbursement The challenge of finding skilled resources The continual stress to do more with less The Experian Health ClaimSource product suite addresses these challenges first by providing excellent products that are all seamlessly interfaced and can provide exception-based processing for: Automation of processing clean claims through the use of an expansive library of national payer edits The ability and willingness to create provider specific custom edits Expediting the follow up process thru the use of enhanced claims status detailed responses Enabling more efficient processing of denials by analyzing denials reasons and automating workflow Automating the payment posting process with customized posting files for handling splits and contractual adjustments Providing the best interfaces available for Epic clients for both hospital and physician billing offices We follow that up by offering superior customer support for our clients. By leveraging our size, experience, and multiple locations in Sacramento, California and our new location in Schaumburg, Illinois, we support clients from Hawaii to New York to Alaska to Florida and everywhere in-between. These two offices allow our clients to get great hands on support for implementations, training, extensive custom programming, as well as experienced billing analysts with decades of billing knowledge. We always thought our claims products stood out against our competition, but now KLAS has validated that for us. Ask your Experian Health account representative or email us at experianhealth@experian.com to find out how we can help your business office address your specific needs.

Experian Health and NCPDP (National Council for Prescription Drug Programs) have joined forces to introduce a vendor-neutral solution that powers a national patient identifier. Experian Health and NCPDP have announced a strategic alliance to provide a vendor neutral solution to address the complexities of managing patient identification. With a shared vision to create solutions and leverage data for the common good, this alliance brings an innovative matching solution that provides the framework for establishing a unique patient identifier to address patient safety, financial and operational challenges across the U.S. healthcare ecosystem. Read the press release here.

Below is a collection of some of most compelling article we've read in recent months. We hope you find these interesting, too! One Goal; One Contract: How a Nationwide Health Data Sharing Framework is Revolutionizing Interoperability https://www.himss.org/news/one-goal-one-contract-how-nationwide-health-data-sharing-framework-revolutionizing-interoperability   7 things to know about Aetna's ACA exchange exit https://www.beckershospitalreview.com/payer-issues/7-things-to-know-about-aetna-s-aca-exchange-exit.html   5 steps to cybersecurity for Internet of Things medical devices https://www.healthcareitnews.com/news/5-steps-cybersecurity-internet-things-medical-devices    CMS: ICD-10 specificity kicks in Oct. 1, 2016 https://www.healthcareitnews.com/news/cms-icd-10-specificity-kicks-oct-1-2016   3 leadership skills crucial for a culture change http://www.beckershospitalreview.com/hospital-management-administration/3-leadership-skills-crucial-for-a-culture-change.html

Scott Lee oversees the Experian Health Reference Program. Scott graduated with a BA in Business Management from The University of Texas at San Antonio, and has been with the organization for 12 years, beginning with MPV, which was acquired by Experian in 2011. Scott lives in San Antonio with his wife and two children and says his second home is the San Antonio Zoo based on how much time he and his family spend there. Scott is a catalyst for fostering the connection between Experian Health’s current and potential clients to allow the former to share their positive experience and ROI using our solutions. Our clients also benefit from being a reference by learning about the workflow and best practices of similar organizations. Because of the importance of protecting our clients’ privacy, Scott schedules calls on behalf of our clients and ensures that the experience is mutually beneficial and minimally disruptive for all parties involved. “We’re very appreciative of our reference clients, and it’s a privilege for our potential clients to hear their experiences firsthand.” he said. Share your story by being an Experian Health Reference Client! Contact your Sales Director/Account Manager or contact Scott Lee at scott.lee@experian.com or (210) 582-6320.

Below is an update from the Experian Health  Support Team. Network & System Performance Last six months: Upgrades to the network, compute and storage infrastructure have improved performance and scalability. Enhanced alerting and reporting to strengthen proactive measures for issues remediation Next six months: Data Center move and consolidation will localize production communications to improve efficiencies Automation improvements to reduce on-boarding times for new clients Subscribe to Receive Product Support Updates Opt in to receive emails about significant product updates or changes. Access the Experian Health Product Dashboard here.    

In case you missed them, below are some great tools to help you address key business challenges. Enjoy the read! Press Releases Innovative Mindset Enables Experian Health to Deliver New Capabilities Experian Health Rises to 45 On The 2016 Healthcare Informatics 100 List   White Paper Why Start the Payment Process Prior to Service? As a patient’s financial obligation grows, it’s imperative to tailor payment strategies to each unique situation. In pre-service stages, data-driven solutions provide a higher likelihood of securing patient payment. Flexible patient payment plans contribute to a positive billing, payment, and overall engagement experience, as well as a provider’s financial health. Read our white paper to learn more about the importance of the Personalization in the Healthcare Consumer Payment Process. Read Now   Article: Healthcare IT Transformation - How Has Ransomware Shifted the Landscape of Healthcare Data Security? Read Now

Did you know that it costs an average of $25 to rework a single claim?  It’s true, according to a recent Health IT News article. The article goes on further to state that as many as 65 percent of denied claims remain unresolved because they are too costly to rectify. These unpaid claims eventually become lost revenue. Experian Health’s Denials Workflow Manager and Enhanced Claim Status solutions are part of an integrated revenue cycle platform for healthcare providers to manage payer billing and payment processes.  Effective management of these processes directly results in improved cash flow, lower days in A/R, and more efficient operations. Clients converting to our integrated claims and denial solution are experiencing a 50% increase in clean claim rates and faster turnaround on cash. Learn more by visiting our Claims Management page or reserve your spot at one or both of our Claims sessions at the upcoming HFMA ANI conference: June 27 | 1:30pm | Manage Denials to Maximize Reimbursement, Revenue and Cash Flow June 28 | 9:45am | Claims Management

Welcome Katie Zibelin, Experian Health Marketing’s newest team member. Katie made her Experian debut in August 2015 as an intern where she supported client events, tradeshows and proposal efforts behind the scenes.  Upon securing her advertising degree from the University of Texas at Austin in December 2015--one semester ahead of schedule--Katie joined the team full time this February. In her current role as a Marketing Coordinator, Katie is responsible for tracking projects, managing vendor activities, conducting tradeshow and vendor research, developing new vendor relationships, coordinating and supervising tradeshow activities and communicating programs and events. Katie also serves as the project leader of our 2016 Regional User Conferences. In her first solo performance at our Southeast Regional Conference in New Orleans, Katie received rave reviews for demonstrating project management and event planning maturity and grace under pressure. Fun Fact: Katie is also an accomplished contemporary dancer/performer/instructor. Please do not hesitate to reach out to Katie with questions regarding any of the upcoming Regional User Conferences at Katie.Zibelin@experianhealth.com.

In the 1930s, Ovaltine offered listeners of the Little Orphan Annie radio program a membership badge with a decoder ring that allowed listeners to replace numbers with letters and figure out secret messages – which usually urged them to drink Ovaltine.. Fast forward to 2015, and a decoder ring can be bought online for under $20. Unfortunately, these trinkets aren’t sophisticated enough to help practices and hospitals decipher reimbursement contracts and identify underpayments. Providers today require robust analytics and automated workflows, coupled with a level of support that goes far beyond an instruction manual to include continual updates to contract terms by skilled contract analysts. According to the American Hospital Association, combined Medicare and Medicaid underpayments were $51 billion in 2013. Private payers further contribute to underpayments, totaling a hefty financial gap for providers, regardless of care setting. It is imperative that providers across hospitals and medical groups take proactive measures to ensure they are paid fully and fairly for the care and services delivered. Incorporating automated solutions enables providers to fully decode the hidden “catches” in contracts while recovering underpayments. Understand how proposed contracts with payers affect your revenues When a payer assures you that proposed contract changes will benefit your organization, are you skeptical? Using contract analysis and modeling, you can accurately predict how a change in any of the hundreds of variables in third-party contracts will affect reimbursement for your precise mix of services. Not only can contract analysis let you see the overall impact of an individual contract, it also lets you precisely model revenues so you can see the gains or losses for each individual specialty, provider or service. By assessing which factors have the greatest impact on your reimbursement, you can refine your bargaining strategy to negotiate better-performing contracts.  Verify the accuracy of payment received from third-party payers Ensuring your contracts are as advantageous as possible is just half the battle; you still have to confirm that payments follow the guidelines of the contract. Complicating this process is the move to new reimbursement structures that bundle payments or base them on value rather than services. Verifying payment accuracy can easily bog down your team–unless you put the benefits of automation to work for you. Contract management and analysis solutions streamline workflow by auditing claims so you spend time only on those that require intervention. Through data-driven insight, you can conduct contract-based appeals and recover lost revenue. Together, these solutions assist in reviewing and modeling contracts, and then accurately identifying, appealing and recovering underpayments. With the ability to value the claims you file and evaluate overall contract performance, you decode the information locked away in data. All without a decoder ring. Don’t miss our upcoming webinar, "Overcoming the Three Ps: Payers Who Pay Poorly” Featured Speakers: Kristen Prenger, Director of Managed Care, Lake Regional Health System Rebecca Charo, Product Director, Experian Health Date: Thursday, May 21, 2015 Time: 11 a.m. PT/1 p.m. CT/2 p.m. ET Register now!