Collections Optimization

According to Experian Health's State of Patient Access 2023 survey, providers think recent efforts to improve the patient financial experience are paying off. But do patients agree? The survey, carried out in December 2022, suggests a disconnect between how patients and providers view the patient collections process. Many providers rate their collections services favorably, having invested in pre-service estimates, flexible payment options and tailored payment plans. However, patients see room for improvement and a chance for providers to improve patient collections. Many say they feel anxious about managing medical expenses, with uncertainty prompting some to consider canceling care or switching providers. Could a more compassionate and personalized approach to healthcare billing help patients navigate their financial obligations more easily? Here are 4 ways providers can improve patient collections and create a patient experience that attracts long-term loyalty. 1. Provide proactive price transparency Patients want to know how much their care will cost before they receive it: almost 90% of patients said receiving a price estimate before care is essential. Providers recognize this, and 67% believe their organization is doing a good job of providing clear, understandable estimates prior to care. Unfortunately, only 29% of patients say they actually received one. Easing Digital Frictions in the Patient Journey, a collaborative survey of 2,333 consumers from Experian Health and PYMNTS, found that 82% of patients living paycheck to paycheck with issues paying their bills consider it “very” or “extremely” important to preview out-of-pocket costs before treatment. Among patients who received surprise bills, 40% spent more on healthcare than they could afford, compared with 18% of patients who did not receive surprise bills. Giving patients early clarity with precise pricing estimates helps them plan so they're less likely to avoid care or struggle with unexpected and unaffordable bills. Payments can also be collected faster and more efficiently. Despite the implementation of price transparency regulations, the incorporation of cost estimates into healthcare billing is not yet standardized, presenting a significant gap in the industry. Healthcare providers who prioritize accurate and easy-to-understand cost estimates are more likely to boost patient satisfaction ratings and increase improve patient collections. 2. Create personalized payment plans Personalized financial pathways are essential in healthcare. Patients have unique financial situations, and a one-size-fits-all approach won't suffice. Some patients may prefer to pay their bill upfront so they know it's taken care of, while others may need to spread out the cost into more manageable installments. Advanced data analytics can help providers create a more positive payment experience by assessing each individual's ability to pay and assigning them to the appropriate financial pathway. For example, Collections Optimization Manager scores and segments patients according to their propensity to pay, and automates the presumptive charity process so accounts are handled sensitively and efficiently. Using automation helped the University of California San Diego Health (UCSDH) deliver better patient experiences, maximize collections and reduce the cost to collect. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH's Systems Director explains that automation allowed them to maximize staff resources to support patients to understand their bills, as well as provided valuable insights into each patient's situation: “We serve our patients well when we can spend time explaining their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, explains how automation helped their organization optimize patient collections and improve patient satisfaction. 3. Provide support to those in need A topic on many providers' minds is Medicaid redetermination, following the loss of Medicaid coverage for millions of patients. Many may be eligible to re-apply, but in the short term, millions could be left floundering financially. Providers can support patients in this situation to sort through coverage, navigate charity eligibility and offer suitable payment plans to keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, says this is both a challenge and an opportunity for providers: “For providers, this may be a hard situation to navigate. At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offer them help can be powerful.” What can providers do as patients lose Medicaid coverage? The priority should be to identify patients who need charity assistance and connect them to any available support. Using credit data and other demographic data points, Patient Financial Clearance screens patients who may still be eligible for Medicaid and finds self-pay patients who may qualify for charity assistance. It also assigns patients to the appropriate pathways and even auto-enrolls them in financial assistance programs so they feel confident they're on the right path. 4. Offer flexible ways to pay Finally, a compassionate billing experience will involve as little friction as possible when the patient comes to making payments. According to the patients who participated in Experian Health's survey, payment experiences should be convenient, transparent and flexible, with 72% expressing a desire for online and mobile payment options. These features are essential to younger generations, who are less tolerant of inflexible, manual systems. Providers should offer a range of payment options that include in-person, telephone, mobile and online patient portals, so patients can pay in a way that's most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statements. Experian Health offers a suite of patient payment solutions that enable consumers to make secure payments at any point in their healthcare journey, through multiple channels. From customizable patient statements to mobile-enabled payment methods, these tools support a compassionate and convenient approach to patient billing, turning what can be a confusing process into one that is more efficient for both parties. Improve patient collections with automated solutions Consumers are the cornerstone of healthcare and providing a consumer-friendly payment experience can make a huge difference. Money is often a sensitive topic for patients, but with a consumer-centric payment experience, financial matters can be handled compassionately. Patients will be more satisfied and more likely to pay in full and on time, and providers can improve cash flow. With the right tools, healthcare billing and collections can become seamless and clear, and patients can pay their balances with ease. See how Collections Optimization Manager and other patient payment solutions can maximize and improve patient collections.

Having the right health insurance eligibility verification software can make or break the healthcare revenue cycle. In fact, there's a direct correlation between the efficacy of an organizations' eligibility verification system and the amount of revenue the organization generates. If there are eligibility verification errors during the process, it can be more difficult to file claims and receive payments. 4 common insurance eligibility verification errors to watch out for: 1. Wrong or incomplete patient data Healthcare providers are responsible for verifying patient coverage. As part of the process, staff checks the patient's identity and contact information to confirm that it matches their electronic health records. Other important verification steps include confirming patient eligibility for proposed services, checking for exclusions and double-checking that the patient's coverage is not only active but that any annual or lifetime limits haven't been exceeded. But when a patient provides incorrect or incomplete information during the early stages of eligibility verification, it can bottleneck the entire verification process. Patients may have moved, switched employers or even switched their insurance coverage. When providers don't have access to the most up-to-date patient data, it can result in eligibility verification errors and create extra work for staff. Incomplete or wrong patient information not only makes the process more time-consuming but can also stall the claims process, resulting in delayed reimbursements or issues getting paid. 2. Incorrect insurance information Verifying a patient's insurance coverage is one of the earliest parts of the revenue cycle. And it can be complex, especially with patients frequently changing insurance providers and taking on more payment responsibility. While a patient insurance ID card is helpful, it doesn't prove eligibility. To verify eligibility, access staff will typically need to check payer websites or call payers directly. They also choose to use clearinghouses to run batch checks. But these options can be laborious and time-consuming. With the end of the COVID-19 public health emergency (PHE), it's also expected that up to 15 million Americans could find themselves without healthcare insurance, making the verification process even more tedious. The US Department of Health and Human Services (HHS) estimates that 8.2 million Medicaid enrollees will no longer be eligible for coverage. And another 6.8 million eligible individuals may lose coverage due to “administrative churn,” which occurs when patients fail to provide annual confirmation of Medicaid eligibility. These wide-scale changes to coverage could increase the risk of insurance information errors and longer verification checks, creating more stress and work for staff, claim denials, uncompensated care and millions in lost revenue. 3. Human errors lead to eligibility verification errors As the volume of patients continues to grow, providers that rely on manual verification processes are potentially at risk for human error. Inaccurate data entry increases the costs associated with medical billing areas and hinders interoperability as more patient data is created, collected and shared. And when incorrect data is entered when billing for services, it can result in disputes with insurance companies, medical billing errors and in extreme cases, a lawsuit and the need for omissions insurance. Performing employment verification checks by hand is also time-consuming and places an extra burden on staff, especially if there are existing staff shortages. Manual eligibility verification can hinder operational efficiency so much that the CAQH reports it adds more than 20 minutes per transaction, at a cost of nearly $10 billion per year to medical providers. Manual submissions can also result in mistakes when inputting claims, and when claim submissions aren't clean, reimbursements can take longer. 4. Unclear communication Provider and patient communication is a fundamental part of verifying coverage, ensuring receipt of payments and creating strong patient/provider relationships. If communication is unclear or rocky, it not only can undermine the trust between a patient and provider, but it can directly result in delayed claim processing, denials and make it harder to get paid. When patients and providers aren't clearly communicating about coverage, co-pays, cost estimates and deductibles, it can make for a stressful patient experience. With 3 in 10 patients expressing concerns about being able to afford a $500 bill, it's critical to inform patients about their financial obligations upfront so they can plan accordingly. How automation can eliminate eligibility verification errors According to an Experian Health survey, one in three healthcare executives say that denied claims happen about 10%-15% of the time, resulting in billions of dollars in lost revenue. Using an automated medical insurance verification system, such as Experian Health's Insurance Eligibility Verification solution, can help eliminate the vulnerabilities of manual patient eligibility verification and pay big dividends across the revenue cycle. Kate Ankumah, Product Manager at Experian Health, says, “If providers don't have a full picture of the patient's payable benefits, deductibles, co-pay thresholds out-of-pocket maximums, and other policy details, they run the risk of non-reimbursement. For that reason, these checks should be carried out before a patient's appointment or procedure, to prevent awkward billing issues and delayed payments. This gives providers peace of mind that they'll be reimbursed for the services they provide and accelerates patient registration.” Not only does automation help relieve the manual burden placed on staff, but it also improves operational efficiency, ensures cleaner claim submissions, speeds up reimbursement, reduces medical billing errors and creates a better patient experience overall. Here's how: 1. Integration with office software systems To keep things running as smoothly as possible, providers should consider automation eligibility tools that integrate seamlessly with their existing systems and interfaces. This can help fully leverage data analytics and streamline operations. Integrating automated solutions with health records can also speed up verification and registration. For example, existing Experian Health clients can access Eligibility Verification through eCare NEXT® which provides a single interface to manage several patient access functions. 2. Real-time connections with major insurance carriers Using insurance verification software can help keep patient insurance information up-to-date. For example, Experian Health's solution connects with over 900 payers instantly, allowing providers to access real-time patient eligibility and benefits data. Plus, it has an optimized search functionality that boosts the likelihood of finding a patient match. It also features an optional Medicare beneficiary identifier (MBI) lookup service that automatically finds and validates MBI numbers, necessary for validating Medicare coverage that many providers report having to look up manually. 3. The ability to calculate a patient's estimated payments Inconsistencies between estimated and actual costs are common patient complaints. By providing estimates upfront, providers can reduce this major source of patient stress. Automating pre-service eligibility and estimates provides patients with a clear view of their financial obligations so they can plan accordingly. Price transparency also empowers patients and can help them feel more in control, improve engagement and increase the likelihood that providers can collect payments faster and more efficiently. Prevent eligibility verification errors to get paid faster Insurance verification is an often underestimated, yet crucial component of the patient experience. Automating this process with advanced data analytics can help minimize denied claims and long-term financial losses while strengthening trust between patients and providers. In short, optimizing for insurance verification early on has wide-reaching benefits throughout a provider's revenue cycle. Learn more about how Experian Health can help healthcare organizations reduce eligibility verification errors and protect their bottom lines.

“With Coverage Discovery, Luminis Health can now find more billable coverage, whether primary, secondary, Medicare or Medicaid. Luminis can follow up immediately with payers when there is no initial real-time eligibility response available. Not only does this improve financial performance, but it also reduces manual work and minimizes errors before claims are filed.” Sheldon Pink, Vice President of Revenue Cycle at Luminis Health Challenge Luminis Health is a not-for-profit health system with an annual revenue of $1.2 billion and over 9000 employees. As one of the top three hospitals in Maryland (according to the U. S. News and World Report), Luminis’ vision is to break down barriers to health and deliver more high-quality care across the region. Finding and verifying insurance coverage for more self-pay patients was contributing to Luminis Health’s levels of bad debt. Staff relied on manual processes that were time-consuming and inefficient, and a vendor solution that did not integrate with Epic®. Limited productivity led to delays, denials and compromised patient experiences. To resolve these challenges, the organization’s goals were to: Create a positive patient financial experience by providing accurate and quick patient financial estimates Reduce bad debt by finding accurate primary and secondary insurance coverage Eliminate manual processes for following up real-time eligibility (RTE) responses with payers Reduce the number of self-pay patient accounts that end up in bad debt Solution With Coverage Discovery, Luminis was able to maximize reimbursement, reduce bad debt and improve the patient experience. Coverage Discovery finds additional active coverage that patients may have forgotten about. Using verified patient information, proprietary databases and confidence scoring, the tool scans for active coverage across the entire patient journey. This means no financial stone is left unturned before the patient is billed directly. By identifying coverage that would otherwise have been missed, Luminis can avoid misclassifying patients as self-pay, and prevent accounts from being incorrectly sent to bad debt or charity. Staff can focus on accounts most likely to be rebillable to insurance, rather than wasting time on avoidable manual rework. In certain instances when patients do not know they have secondary coverage, Coverage Discovery: Verifies patient demographics to ensure patient details are correct Leverages a range of proprietary databases (including Employer Group mapping) and historical patient search information to find insurance that may have been used and verified at other locations Applies a confidence scoring system to reduce the noise and eliminate “false positives,” so the client doesn’t waste time reviewing incorrect information or irrelevant coverage Outcome As a result of using Coverage Discovery, Luminis found more than $240k in active coverage on average per month in 2021. They reduced the number of self-pay patient accounts ending up in bad debt and created positive patient financial experiences by minimizing patients’ financial obligations. Reducing reliance on manual processes also led to fewer real-time eligibility responses from payers. Sheldon Pink reports that implementation was straightforward, thanks to Coverage Discovery integrating seamlessly with Epic® and support from the Experian Health team: “We’re impressed with these results and with the partnership with Experian Health. Luminis is looking forward to building on this success and continuing to collaborate with the Experian Health team.” Find out more about how Coverage Discovery helps healthcare organizations find missing and forgotten coverage, to improve financial performance and contribute to a better patient experience.

Nearly 40% of patients postponed medical care for themselves or a family member in 2022 due to cost. The percentage jumped 12 percentage points in a year, from 26% in 2021 to 38% in 2022, according to Gallup's annual Health and Healthcare poll. While this trend has clear ramifications for healthcare, it's also bound to affect revenue and collections for healthcare providers. Providers need to stay ahead of the curve when it comes to navigating staff shortages, decreased patient volume, and the range of financial problems patients are currently facing. Matt Hanas, Lead Product Manager at Experian Health, shared how providers can improve collections as patients postpone care. Q1: New studies show that many patients are putting off care due to costs. What does this mean for collections? “We're hearing about this very exact concern directly from our clients,” says Hanas, “and it's unfortunate to see patients put off medical care due to rising costs. Patients across our nation are struggling to balance where to allocate their hard-earned dollars, and they're having to make difficult decisions about whether to seek medical care or use that money on their everyday necessities. Meanwhile, healthcare providers are once again adapting to a shifting climate: “Clients are meeting this trend head-on with adaptable plans of action that allow for customizable contact strategies driven by automation and powerful data sources, using Experian solutions like Collections Optimization Manager,” says Hanas. “[Postponed care] doesn't have to be a heavily felt impact in collections if health organizations can quickly and easily adjust their collections strategies according to economic shifts, such as reduced patient volumes.” When volume is down, efficiency is key. “Experian's suite of products allows clients to utilize the tools and data we can provide to pivot on some of their outreach approaches,” Hanas says. “Segmentation results allow them to consider, for example, focusing on lower balance accounts with a consistent pattern of good payment history, or increasing collections efforts on higher balance accounts that may be harder to collect on. Having access to this data and following it is very key in preventing significant revenue interruptions during these patient volume shifts that we are seeing right now.” Q2: How can providers improve collections amid staffing shortages? “Automate as much of your workflow as possible,” Hanas advises. Automation not only reduces the need for staff intervention but also helps manage the complexity that comes with postponed care. Patients who have put off getting medical treatment may require more extensive (and expensive) treatment. If they've postponed care because of cost, it could be a sign that their finances are stretched. A complicated collections environment needs more than additional staff hours; it calls for data-driven insights and automation. “Visibility, powered by data, drives actionable workflows,” says Hanas, who points out that using solutions from Experian Health allows healthcare providers to accomplish more with fewer staff, including: Automatically pushing updates into an EHR system without manual intervention Setting up automated, prescheduled dialing and texting campaigns Prioritizing collections based on propensity to pay Adjusting scrubs and screens on AR files to remove accounts that are unlikely or unable to pay Sending text-to-pay message alerts Giving patients self-service payment options through online portals and mobile apps “I'm not saying you can completely replace the human touch throughout collections,” says Hanas. “But automation, data-driven insights, and user-friendly, self-sufficient payment collection tools can minimize the impact felt from staffing shortages by ensuring that staff collections efforts are efficient, and by offering patients that power, that freedom to use the self-service payment tools they are very eager and willing to use.” The return on investment speaks for itself. “Our collections solutions have a 9:1 return on investment ratio, based on clients' 2022 data,” says Hanas. “We think that's a pretty remarkable ROI.” Find out how University of California San Diego Health used Collections Optimization Manager and Coverage Discovery to increase collections from $6 million to $21 million. Q3: How does access to multiple sources of data improve collections success in the current environment? “Data gives our clients a compass that guides them very precisely, so they know which patients to focus on and what strategies to deploy,” says Hanas. “Experian is one of the largest data aggregators in the world, which benefits products like Collections Optimization Manager heavily—but it doesn't stop there. Experian Health doesn't rely solely on credit data; it also includes non-credit consumer data. We continually partner to grow our arsenal of data sources, so clients have a laundry list of solutions and products powered by this accumulated portfolio of data sources.” Here's how providers are using Experian's suite of collections solutions to help patients and improve collections efforts: Qualifying patients for Medicaid - “Data sources may show coverage that's been simply overlooked or forgotten by the patient,” says Hanas. “For example, Coverage Discovery has found a ton of Medicaid coverage for patients who simply didn't know they had it—or who failed to report it.” Recently, the expiration of the COVID-19 public health emergency caused millions of patients to lose their Medicaid coverage overnight.  In these cases, providing information to patients who are confused about coverage benefits both providers and patients. Hanas notes: “When we find patients are eligible for Medicaid coverage, they're really pleased to find out that their self-pay balances will be covered.” Filtering out difficult-to-collect accounts can improve collections - Screening can save providers valuable time and resources they might otherwise spend trying to collect from patients who are unable to pay. Hanas says, “Simply being able to identify that someone's address is not current or deliverable saves providers money on statement processing and postage—and saves them the trouble of attempting to send a bill that cannot be delivered.” Gaining insight into financial circumstances - “Our data gives our clients visibility into consumers' financial status changes—paying off a car loan or securing a new mortgage, for example, are things that our clients really need to know. By monitoring these financial status changes, our clients can increase or decrease their collections efforts based on what they see,” Hanas explains. Q4: How can providers support their patients who may need extra financial assistance? “Identifying patients who are eligible for charity care and other forms of assistance is probably the most rewarding use of our data, models, and algorithms,” says Hanas. “Patient Financial Clearance, which falls under the Collections Optimization suite of products, shows which patients may automatically qualify for charity. For those who do, clients can set up automation rules on the back end to automatically write off balances. This happens through a seamless integration, so it's virtually effortless. “Providers can also use the propensity to pay tool in Patient Financial Clearance to identify patients with a low likelihood of paying and offer payment plans that may help them meet their obligations. By having these conversations early in the process, healthcare organizations can keep more accounts out of collections and patients can receive medical care without having to worry about what's going to come after their visit.” The bottom line “Clients want to centralize their business operations around their patients and their care, to find the best approaches to looking after patients' health as well as their financial health,” Hanas says. “We don't want to send everyone who has a balance to collections: We want to use the different tools we have to assist them up front so they can get the medical care they need without feeling stressed and thinking about possible bills down the line. Learn more about how Collections Optimization Manager and Experian Health's full suite of collections solutions can help providers protect profits and drive revenue.

U.S. hospitals have been stuck with more than $745 billion in uncompensated care costs for the past 2 decades, and the number continues to grow.  Other factors like patients relocating, changing employers, and coverage renewals make recovering debt even harder. The recent end in COVID-19 funding has also made it more important than ever for healthcare providers to find missing insurance coverage. Finding insurance coverage can be complicated and time-consuming, especially in an already complex reimbursement landscape. However, it doesn't have to be. That's where Coverage Discovery comes in. Coverage Discovery is the only comprehensive coverage identification solution across the full revenue cycle continuum. It covers the entire patient process and uses multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms to search government and commercial payers to find previously unknown insurance coverage. This includes identifying accounts that may be submitted for immediate payment as primary, secondary or tertiary coverages. This automated coverage identification solution can search for unidentified coverage pre-service, at the point of care, and post-service. It also scans for insurance coverage continuously - to maximize reimbursements and minimize accounts sent to collections and to charity.  In 2022, Coverage Discovery tracked down previously unknown billable coverage in more than 28.1% of self-pay accounts and found more than $64.6 billion in corresponding charges. Learn more about this solution: It's time to reduce bad debt and improve cash flow. Identifying hidden insurance coverage is the first step to managing insurance denials and your organization’s healthcare financial performance. A solution like Coverage Discovery can help healthcare organizations save time, money and alleviate staffing shortages. To learn more about how Coverage Discovery can benefit your healthcare organization, contact us.

On April 1, 2023, millions of Medicaid recipients are set to lose coverage as the U.S. government’s COVID-19 public health emergency (PHE) expires. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Of this group, 6.8 million may be eligible to re-apply for Medicaid, but in the immediate term, it falls to patients and providers to sort through coverage questions, navigate charity and Medicaid eligibility, and keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, shares her insights on how Patient Financial Clearance and other digital solutions can help providers and patients cut through the confusion to achieve the best healthcare and financial outcomes during this time. Q1: The public health emergency is ending on April 1, which means that many will lose Medicaid coverage. How will this impact providers and patients? “Patients who qualified for Medicaid under the Public Health Emergency requirements during COVID will be dropped from Medicaid on April 1, leaving them without coverage,” explains Pankoke. “Healthcare organizations have been trying to reach out proactively to pre-enroll some of these patients, but others may not know what their options are or may show up to receive care without realizing they no longer have coverage.” Patients will face a range of financial challenges. “Self-pay patients may defer treatment, which could keep them from receiving the care they need and may ultimately lead to more costly hospital visits,” Pankoke says. “Also, patients may be confused about what’s happened to their coverage and what their options might be going forward. If they end up being responsible for paying out of pocket for care, some may have to choose between paying their medical bills and paying for food or utilities.” Providers will see a surge in patients needing help after losing Medicaid coverage With millions of patients in flux, providers will need to dedicate time and attention to helping patients sort through their concerns, including: Confirming whether Medicaid coverage is still in force Verifying coverage with new insurance Determining eligibility to re-enroll in Medicaid Qualifying patients for full or partial charity care Explaining patient financial responsibility and working out payment plans Managing billing and collections with a higher volume of accounts in AR Optimizing outcomes so that patients get the best care possible and providers end up with the least amount of bad debt Time is a critical element. Lengthy processes and administrative delays are likely to increase patient stress levels. Meanwhile, many providers face industry-wide staffing shortages. Time-consuming manual processes, multiplied by a sudden surge of affected patients, could quickly become overwhelming for staff. “For providers, this could be a hard situation to navigate,” says Pankoke. “At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offering them help can be powerful.” Q2: That raises an important question: How can providers create a compassionate experience for patients? “I think awareness is one place to start: making sure your staff knows this change is coming and that they understand the impact,” Pankoke says. “Your staff are the ones who’ll be working with patients personally when they come in and find out they no longer have Medicaid coverage.” But compassion doesn’t end there. “Many providers already have charity programs in place to provide relief for patients who can’t afford care,” says Pankoke. “The challenge lies in identifying the patients who need that charity assistance and connecting them to the help that’s available, while also learning which patients may still qualify for Medicaid and need help to re-enroll. Patient Financial Clearance uses credit and non-credit data to identify patients who may still be eligible for Medicaid, as well as self-pay patients who may qualify for charity assistance.” Using data-driven digital tools to quickly and proactively size up patient financial needs and offer personalized help can make the patient experience more humane. “Making these steps easier is another piece of being compassionate.” Q3: Screening for charity can be complicated, especially when new regulations are introduced – how do providers streamline this process? “My best advice is to embrace your charity programs and use a partner like Experian Health to help you automate the financial assistance screening process,” says Pankoke. “Patient Financial Clearance removes the manual screening for the likelihood to qualify for your charity programs and Medicaid.  It can automate the document-gathering in a patient-friendly way, and speed up the process to extend charity assistance, or work to enroll those likely to qualify for Medicaid early on before patients go through a costly uncollectable experience.” Automating these processes doesn’t have to be onerous. “Clients can provide their charity policy  requirements to Experian Health and let our expert consultants help to create the most effective and efficient workflows for Medicaid and charity screening both  up-front and as back-end scrubs.” Pankoke also urges providers to consider patient self-screening options as well: “Providers should consider other options aside from paper applications.  We’ve seen clients shrink the application process from 60 days of paperwork down to 3.5 days by enabling patient self-screening options via text.  This creates a better experience for the patient and hospital staff.” Q4: What else can providers do to help patients manage the cost of care? Providers can focus their resources on improving the patient's financial journey—for all patients, not just those who are struggling with their Medicaid status. Pankoke’s suggestions: Reach patients on their preferred channels - “Providers can empower patients with less paper-heavy ways to apply for financial assistance. Text and online applications embedded on your website or patient portal put the power into the patient’s hands using the channels they prefer.” Providers can also offer patients the ability to make payments right from their mobile devices using Patient Financial Advisor, making it easier to pay outstanding bills anytime and anywhere. Use data to gain insight into patient finances and offer personalized options - “In addition to screening for possible charity and Medicaid eligibility, Experian data enables providers to offer realistic payment plan options that consider how much the patient is likely to afford, enabling patients to bite off what they can chew with higher likelihoods of making payments successfully.” Customize collections - Sending patients who are struggling to collections may not be cost-effective or compassionate. “Providers don’t want to hound people for payment if the patient is having trouble covering their basic expenses and could qualify for Medicaid or charity care,” says Pankoke. Using Collections Optimization Manager, providers can tailor collections processes to their own specific needs. “A partner who is agnostic to your in-house and early-out agencies can help you manage, monitor, and optimize agency performance for maximum revenue.” Providers who are concerned about upcoming shifts to Medicaid coverage may want to consider leveraging solutions like Patient Financial Clearance, Collections Optimization Manager and Patient Financial Advisor to help them meet this challenge—along with the many challenges of managing patient financial needs in a rapidly-changing world.

Clear, convenient and compassionate – patient-friendly billing should check off all three. But how many patients see this in practice? For many, the healthcare billing and payment process can be intimidating, confusing and rooted in paper-based systems that are slow and prone to error. With the right technology, providers can improve the billing experience by making it easier for patients to understand their financial responsibility and plan their payments. Online patient payment software can streamline the billing process by giving patients more flexibility and control. Here are 5 patient-friendly billing practices that providers can implement to improve the patient experience and protect revenue: 1. Provide proactive and reliable cost estimates Patients don’t want to feel like they’re in the dark when it comes to figuring out their financial responsibility. Unfortunately, too many receive no upfront estimates of the cost of care or receive estimates that aren’t accurate. This financial uncertainty can have a knock-on effect on patient care and provider cash flow. A survey by Experian Health and PYMNTS found that 46% of patients had canceled care after receiving a high-cost estimate, while 60% of patients with out-of-pocket expenses said they would consider switching providers after receiving inaccurate estimates. Patient Payment Estimates generates accurate, personalized estimates for each patient before and at the point of service. The patient’s liability is clearly broken down so they know exactly what to expect. Patients feel more in control and can make quicker, better decisions about how and when to pay (including paying upfront if they wish). This tool also helps providers comply with the Hospital Price Transparency Rule. 2. Eliminate confusing billing information In the age of Amazon, patients expect billing information to be clear, accessible and provided through their preferred channel. Long paper statements sent by mail or a single phone number to call during limited office hours likely won’t cut it. Providers should consider a multichannel approach that uses relevant patient financial data and consumer preferences to deliver personalized options. PatientSimple® is a self-service payments portal that allows patients to view statements online, generate pricing plans and manage their bills, all from a single dashboard. Patients can get automated email reminders and even pay in full. When patients have all the information they need at their fingertips, providers can spend less time handling queries and chasing payments. 3. Find missing coverage early Another ingredient in patient-friendly billing is to help patients reduce their liability, by tracking down any insurance coverage that might have been forgotten. Many patients relocated or changed employers during the pandemic, leaving many unclear about their current coverage. They may be misclassified as self-pay or assumed to have only one form of insurance. Coverage Discovery automatically checks for any active coverage that may have been missed. In 2021, Coverage Discovery tracked down previously unknown billable insurance coverage in more than 27.5% of self-pay accounts, finding over $66 billion in corresponding charges. This greatly reduces the financial burden on patients, while increasing reimbursement rates for providers. It’s just one example of a non-patient-facing tool that works behind the scenes to streamline patient collections. Discover how Stanford Health Care collaborated with Experian Health to optimize collections and improve the patient experience with Coverage Discovery and Collections Optimization Manager.  4. Patient-friendly billing requires personalized payment plans When it comes to payment, some patients will prefer to pay upfront and in full, while others want or need to spread out the cost into more manageable chunks. Providers can pull together financial, demographic and consumer data to point patients toward the right pathway. This is how Patient Financial Clearance works: patients are guided to a payment plan that makes the most sense for their individual situation, with a clear breakdown of what they’ll need to pay and when. Patients are automatically screened for financial assistance programs and can fill out applications online. 5. Allow convenient and flexible ways to pay Patients want simple and easy ways to pay. They expect a choice of quick and convenient digital payment methods that can be accessed anytime, anywhere. The preference for digital payment solutions is especially apparent among younger generations. More than half of millennials say they’re “very” or “extremely” interested in digital services. With online patient payment software, patients have the option to pay multiple providers at once, using multiple forms of digital payments. They can store credit card information on file or set up a digital wallet, and set up automatic recurring payments to stay on track. Offering secure, flexible and instant payment methods to patients from the start of their healthcare journey increases the chance of prompt payment. Patients are free to focus on their health, while providers will see an increase in cash flow with less time spent on collections. Patient-friendly billing practices create better patient experiences  Outdated patient portals, poor communication and clunky billing processes do not make for a patient-friendly financial experience. The good news for providers (and their patients) is the growing menu of digital tools to offer patients the clarity and flexibility they expect. Experian Health President Tom Cox says: “Payment options are increasingly digital and more convenient, payment plans are more common, and price estimates have become less of a rarity. There is also greater use of non-clinical data to get a broader view of patients and their unique financial solutions. Data, coupled with the right technology, can help providers make sense of it all and enhance the patient journey.” Find out more about how Experian Health’s online patient payment software can help healthcare organizations build a modern financial experience to benefit patients and providers.

“With rising patient costs, there has been a need to increase engagement and keep costs low, while utilizing our resources wisely. Collections Optimization Manager is doing that for us, saving time and resources.” — Kristine Grajo, Director of the Self-Pay Management Office at Stanford Health Care Challenge Stanford Health Care is a level-1 trauma center operating between San Francisco and San Jose. In pursuit of its mission to heal humanity through science and compassion, it delivers clinical innovation across inpatient services, specialty health centers, physician offices, virtual care offerings and health plan programs. With more than two million outpatients going through its doors each year, Stanford Health Care is alert to the impact of growing patient financial responsibility. To increase collections and deliver an outstanding patient experience, the organization looked for ways to increase efficiency, reduce manual workloads, and reduce costs using data-driven insights and automation. They set out to: Use data-driven insights to remove uncollectible accounts Maximize patient collections by prioritizing patient collection inventory Identify missed coverage on true self-pay and Medicare accounts Decrease manual interventions and collections calls and improve efficiency Reduce the cost to collect, particularly around contingency fees with third-party collection agencies Solution Stanford Health implemented Collections Optimization Manager to maximize recovery and reduce costs. This tool scrubs accounts that shouldn’t be targeted for collections, so staff can focus their time in the most efficient way. Using machine learning and data-driven insights, the tool scores, segments and prioritizes patient accounts based on ability and propensity to pay. This allowed Stanford Health to recover revenue efficiently while providing positive patient experiences. Finding missing coverage was another strategy to boost reimbursement and avoid billing patients unnecessarily. Experian Health’s Coverage Discovery® solution finds billable primary, secondary and tertiary coverage using the Collections Optimization Manager AR file. Accounts that would otherwise have been sent to collections or written off can be identified and submitted for immediate payment. Listen in as Kristine Grajo, MBA, Director, and Teresa Ceja-Diaz, Vendor Management Analyst, at Stanford Health discuss how Experian Health helped their organization optimize their collections strategy. Outcome With Collections Optimization Manager and Coverage Discovery, Stanford Health achieved the following results: $4.1m increase in average monthly payments (2019-2021) Efficiency gains of $109k per month and $1.3 million annually Saved 672 hours per month by automating the screening of patient accounts, and processed 4,296 accounts 29% of all Coverage Discovery searches resulting in coverage found Stanford also incorporated PatientDial and had efficiency gains of 900 hours per month, while automating 27,000 outbound calls. A further $1.26m in annualized collections was recovered thanks to Experian Health’s Return Mail solution, which ensures that patient accounts contain only accurate, current patient addresses. With accurate patient information on file, the organization can process accounts with greater accuracy. This saves a huge amount of staff time while improving the patient billing experience. "We have received a lot of positive feedback with Collections Optimization Manager’s Return Mail solution because it gives us the most updated contact information. Whenever we need to notify the patient, we have the most updated addresses in our system.” — Teresa Ceja-Diaz, Vendor Management Analyst, Self-Pay Management Office at Stanford Health Care Find out more about how Collections Optimization Manager and Coverage Discovery help healthcare organizations accelerate collections and deliver an outstanding patient experience.

“We serve our patients well when we can spend time explaining their bills, what’s been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at University of California San Diego Health (UCSDH) Challenge University of California San Diego Health (UCSDH) is one of the top health systems in the United States, ranked number one in San Diego by US News and World Report. With more than 9,000 employees, it generates over $2 billion in net patient revenue each year. Patient collections are managed by the Shared Business Office (SBO), which handles all queries about billing, financial assistance and payment plans. Providing a best-in-class financial experience for patients is the SBO’s top priority. The team implemented a three-part strategy to improve the patient billing experience and increase collections, focusing on people, processes and technology. They saw opportunities to use automation to support this. Solution The SBO implemented Experian Health’s Collections Optimization Manager to improve collections and deliver an outstanding patient experience. Using in-depth data and advanced analytics, this tool scores and segments patients according to their propensity to pay and automates the presumptive charity process, so patient accounts are handled efficiently. This helps UCSDH reduce the cost to collect by maximizing staff and agency resources. To further reduce the risk of bad debt, the SBO uses Coverage Discovery® to find billable commercial and government coverage that was previously forgotten or unknown. Listen in as Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, discusses how their organization used automation to optimize patient collections and improve the patient experience. Outcome Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH also used segmentation data to improve outbound call campaigns. The team was able to create automated messages that can be sent to specific segments, so patients get the right information at the right time. By sending during time periods when patients were most likely to respond to calls, they were able to increase their collections rate. The screening feature also identified patient accounts that were eligible for Medicaid or charity support, deceased or bankrupt, and placed them in the correct work queue. The SBO leveraged Return Mail to run checks against patient addresses, to ensure that statements and refund checks were sent to the right place. Accounts with non-verified addresses were allocated to an auto-dialer for automated outreach. This helped reduce the manual labor required to find patient addresses, reduce bad debt and realize improved collections rates. By leveraging these tools, UCSDH has achieved: Increased collections from $6 million in 2019-2020 to $21 million in 2020-2021, a 250% increase Autodialer outcomes 2020-2022: 2,818 connects on return mail accounts 8% collections rate Return mail updates 2020-2022: 10,630 new and improved addresses found 55% hit rate Screening outcomes: 1,700+ deceased patient accounts identified between 2020-2022 2,700+ patient accounts associated with bankruptcy identified between 2020-2022 And thanks to Coverage Discovery, UCSDH has tracked down active insurance coverage amounting to more than $5 million in 2021. More than $4 million in coverage was found for patients under the California Medical Assistance Program. Had this coverage been missed, these amounts would have been written off as bad debt. Finding missing coverage outcomes:  $5M+ value of coverage found in 2021 19% hit rate in 2021-2022 (4% increase from the previous year) $4M+ value of Medi-Cal coverage found in 2021 9% hit rate in 2021-2022 for Medi-Cal scrubs Discover how Collections Optimization Manager and Coverage Discovery can help healthcare providers improve the patient billing experience while accelerating collections and reducing bad debt.