Healthcare consumers should find it easier to access information about how much their care will cost, with the Government’s twin price transparency final rules both now in effect. The Transparency in Coverage Final Rule came into effect on July 1, 2022, placing new requirements on health insurers to disclose rates for specific items and services. This follows the similar Hospital Price Transparency Final Rule, which came into effect in January 2022. Taken together, the regulations are a significant step toward helping Americans understand and plan for the cost of care. However, this means that providers will need to implement healthcare price transparency tools to help them follow these regulations. While it remains to be seen how health insurers will fare, implementation has not been straightforward for many hospitals: only 16% achieved full compliance as of August 10, 2022. No fines have been issued yet, but with the maximum penalty increasing from $300 per day to $5500 per day in 2022 (up to $2 million per year), providers are under pressure to resolve compliance issues. To support this, Experian Health and Cleverley + Associates have joined forces to introduce new healthcare price transparency tools that providers can implement now. Bridging the price transparency gap When consumers don’t know how much their care will cost, they’re more likely to delay or default on payments, avoid care, or consider switching to a different provider. Transparent pricing should help consumers shop around for affordable, high-quality services and estimate the cost of care in advance. However, there’s still some work to do to close the gap between expectations and reality. Despite the legislative changes, patients continue to receive inaccurate estimates and unexpected medical bills. Survey data from Experian Health and PYMNTS found that of these patients, 4 in 10 ended up paying more for healthcare than they could afford. Even where the required pricing information is available, it’s often too complex to meaningfully inform patients’ healthcare decisions and financial planning. Experian Health and Cleverley + Associates have partnered together to offer providers a solution for the list of 300 shoppable services and a machine-readable file for items and services offered. This can help providers deliver better patient experiences with accessible pricing information. Healthcare price transparency tools are the key to compliance Under the Hospital Price Transparency Final Rule providers must display payer-specific rates for 300 shoppable services in a consumer-friendly format. Experian Health’s Self-Service Patient Estimates solution facilitates the first requirement, by enabling providers to list shoppable services and deliver accurate estimates to patients. It draws in current chargemaster data, payer-negotiated rates and patient benefits data so estimates are as accurate as possible. Patients receive a personalized estimate with links to convenient payment methods. Providers can deliver a better patient experience and increase upfront collection rates while minimizing the admin burden associated with manually uploading price lists. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their financial responsibility straight to their mobile device, again connected to payment options. It’s designed to arm patients with a clearer understanding of their costs and payment options, so they’re better prepared to manage their financial responsibility. The price transparency mandate also requires providers to make available a machine-readable file for items and services offered by the hospital, including gross charges, cash prices for self-pay patients, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. Under the new partnership, these machine-readable files are powered by Cleverley + Associates. The files incorporate standardized payer-specific negotiated charge formats and providers can access consultancy support to manage price changes. These files are created using the following process: Model the payer-specific contract terms and rates Apply those terms and rates to patient claims to determine the amount to be paid Assign a Medicare Severity Diagnosis-Related Group (MSDRG) and Ambulatory Payment Classification (APC) to each claim Calculate the median expected payment for items and services by MSDRG, APC and the relevant payer Disclose payer-specific negotiated charge on machine-readable file. An enhanced option is available which allows hospitals to benchmark prices, evaluate different pricing scenarios, and select the most appropriate pricing strategy. That strategy can then be incorporated immediately into the transparency file, so the output is based on the most current data. With this model, Experian Health and Cleverley + Associates can help providers meet both parts of the price transparency mandate. Leverage price transparency investments to improve consumer satisfaction While upfront estimates and clear pricing information are essential for compliance with the Final Rule, providers can further assist patients to manage payments by offering swift support to those who are entitled to financial assistance. Patient Financial Clearance automatically screens patients before or at the point of care to see if they’re eligible for financial assistance, Medicaid or other financial support. Experian’s proprietary Healthcare Payment Risk ScoreSM predicts propensity to pay, so patients can be assigned to the most fitting financial pathway. The final piece of the patient-friendly pricing puzzle is offering clear and convenient ways to pay. Patients welcome a choice of payment methods, including access to the same digital payment tools they use in other purchasing experiences. Experian Health’s Patient Payment Solutions enable providers to securely accept multiple payment types, including eChecking, credit cards (which can be kept on file), and recurring billing. PatientSimple brings all of this together to allow patients to pay balances, see payment plans and apply for charity care via a single self-service portal. Find out more about how Experian Health and Cleverley + Associates are supporting healthcare organizations to implement price transparency tools, comply with regulations and deliver outstanding patient experiences.

When it comes to medical coding and billing, accuracy is everything. Even the smallest error can result in a claim being bounced back by the payer, causing delays and missed revenue opportunities. Coding requirements change frequently, and with denials totaling billions of dollars per year, providers can’t afford to risk under- or over-coding or relying on outdated codes. Automation and software-driven solutions can uncomplicate the complex world of medical coding. Getting claims right the first time accelerates the adjudication process, leading to faster and higher reimbursements. Providers can make more reliable financial forecasts, avoid losing time reworking rejected claims, and give patients greater clarity about what they’ll owe. For this reason, providers should brush up on medical coding and billing best practices to improve claims management and maximize reimbursements. Here are 7 areas to focus on: 1. Stay up-to-date with coding changes Medical codes convert information about the patient’s healthcare encounter into an electronic format that payers use to adjudicate claims for reimbursement. If a claim includes outdated, incorrect or missing codes, then it will be denied. The most common medical coding systems include: International Classification of Disease 10th edition (ICD-10) codes: these codes denote the patient’s diagnosis or condition. The 11th version was published in January 2022, and while the implementation timeline in the US remains unclear, providers will need to be ready to adapt. Current Procedural Terminology (CPT) codes: Where ICD codes describe the patient’s symptoms, CPT codes record their treatment. If there’s a discrepancy between diagnosis and treatment, the claim is likely to be denied. Healthcare Common Procedure Coding System (HCPCS) codes: the Centers for Medicare and Medicaid Services (CMS) use these to apply CPT codes to procedures, services, products and equipment offered to Medicaid and Medicare patients and those covered by private insurance. These codes are constantly being revised and are often recycled, so coders must pay close attention to avoid errors. National Drug Code (NDC): claims need to include NDC codes when the patient is taking prescribed or over-the-counter medications. The NDC directory is updated daily. Diagnosis-Related Group (DRG) codes: these combine ICD and CPT codes to determine the final amount that a hospital can be reimbursed. CMS assigns annually calculated weightings to DRGs based on severity and length of illness, treatment trends and other factors. There are also multiple coding directories for different specialties, such as dental care, mental health and patients with disabilities. With hundreds of thousands of constantly-changing codable terms to consider, medical coders face a daunting task. In the past, coders would rely on manual coding directories to find the right codes, but today, most use digital encoders and digital coding libraries to generate electronic codes. For example, Experian Health’s claims management software integrates government and payer edits so that no changes to coding requirements are missed. Each patient encounter can be processed in real time and incorrect codes can be flagged before the claim is submitted. 2. Automate the claims management process to increase medical billing and coding accuracy Manually matching each patient encounter to a specific set of codes is time-consuming and vulnerable to errors. Software programs improve the process by analyzing unstructured clinical charts and notes to draw out information relevant to the claim. They can cross-reference multiple coding directories in an instant to identify the correct code. They also compile data in standardized, interoperable formats so information can be exchanged between coding and billing teams, clearinghouse staff and payer systems with ease. While some of the output generated by machine learning systems still needs to be checked by human eyes, automated solutions drastically reduce the burden on staff and ensure greater accuracy. With automated claims management, medical coding and billing teams can optimize their workflows, submit cleaner claims, and get insights into the root causes of denials. Case study: see how Summit Medical Group Oregon – Bend Memorial Clinic used automated claims management technology to achieve a primary clean claims rate of 92%. 3. Eliminate workflow inefficiencies to save time According to the Council for Affordable Quality Healthcare (CAQH), automation could save more than an hour of staff time for every three claim status checks. Automation frees up staff to focus on the highest priority tasks that require a human touch. Fewer errors mean less time spent on reworking denied claims. And if claims are processed more quickly, this means that they reach the payer adjudication stage sooner which ultimately will result in faster payments. The medical coding and billing process takes anywhere from a week to a few months, so every hour saved makes a difference. To this end, Enhanced Claim Status monitors how claims are progressing through the claims adjudication process, reducing the amount of time staff need to spend interacting with payers. It eliminates manual follow-up and allows teams to address pending, returned, denied and zero-pay transactions before the Electronic Remittance Advice and Explanation of Benefits are processed. Worklists are generated based on actionable data so staff can work more productively, and claims get settled sooner. 4. Customize claims edits to your specifications One way to drive up medical coding accuracy is to use customized claims edits. Some claims management software solutions only apply updates using universal claim edits or using groups of edits. This doesn’t work for large medical groups that need to cover multiple combinations of payer, specialty and geographical edits. Since no two payer policies are the same, claims edits would need to be checked manually to make sure nothing has been missed. Experian Health’s claims management software solves this by incorporating government and commercial edits alongside client-specific customized edits. Providers can keep pace with changes and capture the requirements of all reimbursement policies that are relevant to a particular claim. For example, ClaimSource runs front-end claims editing to coordinate federal, state and commercial payer edits together with customized provider edits to avoid coding errors. Similarly, ClaimScrubber automatically reviews and adjusts claims, helping medical groups streamline claims submissions. 5. Upgrade record-keeping technology to maintain medical billing and coding accuracy If patient records are peppered with typos and outdated contact information, then it’s highly likely that errors will be inherited on claims forms. A fifth of patients have spotted errors in their health records, including incorrect details about diagnoses, medications and test results. Preventing these errors is key to maintaining medical billing and coding accuracy. Interoperable electronic patient records protect against inaccuracies by creating a single, complete record for each patient. With a tool such as Universal Identity Manager, patient data is matched against multiple data sources to verify that the record is complete and accurate. Staff can have confidence that all information held on a patient will be taken into account when their medical encounters are coded, and avoid coding discrepancies that can occur when a patient’s treatment doesn’t seem to match their diagnosis. 6. Double-check claims before submitting  Running a line-by-line review of each claim before it’s submitted means errors can be found and fixed before they result in financial losses. This would be a painstaking task to do by hand, but with tools such as ClaimSource and ClaimScrubber, hospitals and medical groups can audit claims automatically to check for coding discrepancies or missing patient information. A streamlined claims cycle benefits payers and patients too. Payers can adjudicate accurately coded claims more quickly without pushing them into a queue for manual review, and patients get earlier clarity about how much they’ll owe. 7. Audit the claims management process to spot medical coding inaccuracies Finally, it makes sense to undertake regular audits of the medical coding and billing procedures to weed out any recurring issues. While a coding audit will focus on coding accuracy and compliance, a billing audit can investigate the systems and processes involved in everything from patient eligibility verification to patient collections. This helps uncover recurring issues with under- and over-coding, use of redundant and retired codes, non-compliance and poor documentation. Again, maintaining robust, quality data and records will make this process easier. Partnering with a single, trusted vendor to deliver an end-to-end claims management solution can help achieve this. Find out more about how Experian Health’s automated claims management solutions can help healthcare organizations maintain medical billing and coding accuracy, drive down denials and create a more predictable revenue cycle.

Paying for healthcare has long been a complex experience for patients. Inflation means more families are tightening their wallets, so the demand for clarity and flexibility is increasing. At the same time, the pandemic’s digital legacy means patients have had a taste of contactless and online payment methods – and they want more. This means that providers will have to focus on creating a better patient payment experience. Could a modern financial experience that benefits patients and providers finally become the norm? Experian Health President Tom Cox addresses this question in a recent PYMNTS publication of healthcare leaders’ predictions for the second half of 2022. Concerns about economic uncertainty, along with a desire for more financial predictability, means that providers can benefit from delivering a better patient payment experience. How? These 3 emerging trends could guide the way: 1. Patients expect a frictionless payments experience As patients bear more financial responsibility, they expect paying for healthcare to be as easy as buying a new sweater. Experian Health and PYMNTS data found that one-quarter of consumers used digital methods to pay for their most recent healthcare visits, with patient portals being the most common at 14%. Contactless and mobile payments are also becoming more popular. To eliminate friction, providers must start by identifying the pain points in their payment processes. Do patients know in advance how much their bills will be? Are they given advice and options to spread out payments if they can’t afford to pay the entire bill in one shot? When it comes time to pay, can they find a familiar and convenient payment method? Providers that can answer yes to these questions will have the edge when it comes to delivering a satisfying patient payment experience. When it takes an average of more than 30 days for providers to get paid, any strategies to make it easier for patients to pay sooner and in full will help provider cash flow. Offering quick and convenient digital payment methods that patients can access anywhere, pre-and post-service, will be the key to delivering a better patient payment experience and accelerating collections. 2. Amidst concerns about cost, patients want transparent pricing New research by Experian Health and PYMNTS found that consumers who were under financial pressure were more likely to cancel appointments out of concerns about costs. More than 2 in 5 patients who received inaccurate estimates ended up spending more on healthcare than they could afford. It’s no wonder that 6 in 10 patients who received an unexpected bill or inaccurate estimate say they would switch healthcare providers for a better experience. Cox notes that alongside consumer demand for a better patient payment experience, regulatory change is giving providers a further nudge toward price transparency: “The Hospital Price Transparency Final Rule and the No Surprises Act have put accurate data at the forefront of efforts to transform the patient’s financial experience. Together, these regulations can create the same pricing experience that consumers enjoy in other verticals, namely knowing the cost before making a purchase.” To date, implementation has been patchy. In August 2022, only 16% of hospitals were found to be compliant with the federal price transparency rule. In a recent conversation with Healthcare Finance News, Experian Health’s Chief Commercial Officer, Jason Considine, acknowledges that providing accurate estimates takes work: “Getting these estimates involves having information about the patient's benefits and insurance plan to create an accurate estimate… On top of mind for most provider organizations is an expectation of spending to increase for technology as regulations expand.” Investing in the right technology can help providers deliver financial clarity to patients. For example, Patient Estimates is a web-based price transparency tool that generates accurate estimates for patients before and at the point of service. It can also direct patients to payment plans and charity care, to help them plan and spread out the cost of care. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their expected financial responsibility delivered straight to their mobile devices, and offers methods to make a secure payment. 3. Digitalized patient payments require better data and analytics Maximizing the impact of the above strategies relies on having the right data and technology in place. For example, in Accessing Healthcare: Easing Digital Frictions in the Patient Journey, Experian and PYMNTS found that patients may pay in person most often, but at least a quarter would prefer to pay online. Some may want to pay in full while others want to spread the cost. How can providers tailor their approach if they don’t know which patients want which option? Considine says that “Providers have to figure out the right financial pathway. It takes leveraging data to know the right financial experience." Achieving this requires a combination of consumer data, financial information and demographic details to create a complete picture of each patient’s needs and preferences. Patient Financial Clearance leverages Experian’s unrivaled datasets to calculate an optimal payment plan for each patient, based on their unique situation. Patients are guided to the right plan, giving them a sense of confidence about what to expect. It automatically screens those who can afford to pay upfront and those who may need more time. It’s a more supportive experience for patients and increases point-of-service collections for providers. Another option is PatientSimple®, which identifies the optimal financial pathway for consumers and makes that pathway available through its consumer-friendly, mobile-compatible, self-service portal. In short, patients want better payment methods, upfront price estimates and personalized payment plans. Data and technology can bring these to life. Find out more about how Experian Health can help healthcare organizations deliver a payments experience that meets and exceeds patient expectations, complies with regulatory change, and accelerates collections to help providers ride out financial uncertainty.

Does a patient’s age influence their experiences with rising healthcare costs? A recent report from Experian Health and PYMNTS points to a generational gap when it comes to the impact of and responses to medical bills. The study takes a deep dive into how Gen Z, millennials, Gen X and seniors are reacting to the growing cost of care. From canceling appointments to being surprised by out-of-pocket expenses, this article looks at the key differences in generations and healthcare costs, and the tools and solutions providers can implement to support their patients. Millennials are most likely to cancel appointments due to high-cost estimates A worrying proportion of patients are choosing to delay or forego care because of concerns about cost. This seems to be felt most acutely among younger patients. According to the new data, 74% of millennials and 56% of Gen Z patients have canceled a healthcare appointment after receiving a cost estimate that was higher than they could afford, compared to 13% of baby boomers and seniors. Gen X patients fell in the middle, with just over half canceling appointments after receiving high estimates. That said, healthcare costs affect all generations. While older patients seem less likely to cancel appointments due to cost, the “Medicare Effect” suggests that many hold off seeking care in the first place, until their costs are covered at age 65. Many households, regardless of demographic, are walking a financial tightrope as inflation continues to climb and patients bear responsibility for a greater portion of healthcare costs. Providers can help minimize the number of patients forgoing essential care by helping to track down any available coverage, so patients aren’t inadvertently billed for care that could have been covered by a forgotten health plan. Coverage Discovery continuously scans commercial and government coverage using multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms. Finding missing coverage means upfront estimates will be more accurate, and patients will be likely to see a lower co-pay amount. In 2021, Coverage Discovery tracked down previously unknown billable coverage in more than 27.5% of self-pay accounts and found more than $66 billion in corresponding charges, removing a huge burden for patients and providers alike. Gen Z patients are most surprised by out-of-pocket expenses Overall, 19% of patients found they spent more on healthcare than they could afford in the last 12 months. As would be expected, those who received inaccurate estimates (43%) experienced more financial distress than those who received accurate estimates (26%). Among those who paid out-of-pocket expenses for their most recent healthcare visit, Gen Z patients were the least aware that they would be required to make a payment, with 32% not knowing that they’d need to make co-payments. Only 20% of Gen X and 10% of baby boomers and senior patients were unaware. One way to alleviate the strain of unexpected bills is to issue cost estimates automatically, before the patient’s visit. Only 34% of surveyed patients received estimates automatically before their visit, so it’s no surprise that many are caught unaware when the final bill arrives. With Patient Estimates, patients get a breakdown of their expected costs based on real-time provider and payer data. The estimates are delivered automatically to the patient’s mobile device (along with links to convenient payment methods. An earlier report by Experian Health and PYMNTS found that patient satisfaction rose by 10% when billing estimates were provided, underscoring their value. Millennials pay the highest out-of-pocket expenses Millennials appear to have been hardest hit by out-of-pocket bills. The average across all respondents was $363, but millennials paid an average of $619. This could explain why millennials were more likely to cancel appointments. Providers can help patients manage balance bills by providing tools that make it easier to plan and pay their bills. For example, Patient Financial Clearance screens and segments patients so providers can help guide them to the most suitable financial pathway. PatientSimple and Patient Financial Advisor help patients access cost estimates, identify best-fit payment plans, apply for financial assistance and make payments, via their patient portal or mobile device. Baby boomers and seniors are most satisfied with the healthcare payment process Most patients were generally satisfied with the payment process for their medical bills. Older patients appeared to be slightly more content, with 77% of baby boomers and seniors saying they were satisfied, compared to just under 70% of Gen X and millennial patients. Gen Z was the least satisfied, at 60%. With 22% of unsatisfied patients saying they’d consider switching providers, getting the payment experience right is high stakes for providers. So, how can providers improve the payment experience for those who are less than completely satisfied? Accurate estimates, tailored payment plans, clear communication and convenient payment methods will all be in the mix. For most healthcare organizations, this will mean embracing digital tools and automation. Experian Health’s State of Patient Access 2.0 survey revealed that while younger patients may be especially receptive to a digital patient payment experience, it crosses generational lines. Members of “Gen C” – digitally-connected consumers of all ages – are looking for a streamlined payment experience. When patient loyalty and decisions about when to receive care are so heavily influenced by the financial journey, it makes sense to offer digital estimates, billing and payments where possible. The good news for providers is that prioritizing patient satisfaction doesn’t mean sacrificing efficiency. Automation and digitalization can facilitate greater choice and convenience for patients, without requiring additional staff input. In fact, it’s likely to yield productivity gains and free up staff to focus on delivering an even better patient experience, and support patients to get the care they need. Find out more about how Experian Health’s suite of patient payment solutions can help providers deliver a financial experience that satisfies patients of all generations and healthcare costs.

Automated claims processing could solve one of the biggest challenges currently facing healthcare providers: maximizing reimbursements by minimizing denied claims. Denials have been steadily increasing over the last few years. An MGMA Stat survey found that nearly seven in ten providers witnessed a jump in denials during 2021, although the trend took hold even before COVID-19 hit. If providers rely on outdated systems and tools to process the growing volume of claims, it's inevitable that denial rates will continue to climb. It's not surprising then that a new Experian Health survey revealed almost 3 in 4 providers stated that reducing claim denials takes precedence over other priorities. Getting claims right the first time is no easy task. Traditionally, the claims management process has been labor and time intensive. Claims teams spend hundreds of hours gathering documentation, preparing claims for submission, engaging with medical clearinghouses, and then monitoring claims adjudication while they await the payer's verdict. Should a claim be denied, more staff hours may be required to rework it for a second attempt at reimbursement. Even if administrative budgets and staffing numbers increased in line with demand, inefficient manual systems can no longer bear the burden of data to be managed. With more providers heading into the danger zone of claim denials, automated claims processing tools are growing in popularity. These enable more efficient claims management, boosting productivity, easing pressure on staff, and above all, minimizing denials. Experian Health's survey found that 78% of providers are open to replacing current technologies if they are presented with compelling ROI projections, reflecting the urgency of the situation. What is automated claims processing? Automating claims involves the use of digital technology, software, machine learning and advanced analytics to optimize healthcare claims management. This can include: pre-filling data into digital forms to avoid data input errors using intelligent document processing to pull unstructured information into a single, usable format comparing data from multiple sources and flagging inconsistencies providing real-time insights and status updates allowing multiple parties to work from interoperable data Tools such as robotic process automation (RPA) can be used to replace manual activities, using data, logic and business rules to make decisions within certain parameters. This eases pressure on busy staff and improves efficiency, for example, when prioritizing claims to be reworked. Imagine how much faster a software program can synthesize hundreds of current and historical data points, compared to a human trying to do the same job. There are opportunities to automate just about every stage of the claim lifecycle, from the patient's first interaction with their provider to reimbursement. For example, automation can be used to: Streamline patient onboarding and automate identity checks to avoid errors in patient information Verify insurance eligibility and run continuous coverage checks to see if the patient's status has changed Maintain a complete electronic health record that follows the patient throughout their healthcare journey, so claims contain correct information Track payer policy changes and apply custom edits so that coding information is correct Scrub claims to find and fix any errors before they are submitted Submit claims to payers and monitor the claims adjudication process Optimize the denials management workflow and prioritize denied claims for resubmission Verify reimbursements and initiate patient billing processes. Virtually any repetitive, process-driven, or paper-based task from claim creation to claim reimbursement is an opportunity for automation. As technology advances, so do the opportunities to streamline operations, reduce time to reimbursement, optimize decision-making, reduce costs and improve the patient experience. Here are the 5 benefits of automated claims processing: 1. Automated claims processing streamlines operations Automation's number one benefit is allowing providers to move away from inefficient and error-prone manual processes. Staff no longer need to sift through disparate and complex coding lists, medical records and payer edits looking for the correct information to attach to a claim. Together with electronic records management, automation allows for standardized workflows, so the entire claims cycle is more consistent, and decisions are based on real-time accurate data. It helps to eliminate time spent searching for missing information, reformatting data to meet payer requirements, and trying to figure out which claims are worth reworking. Multiple digital tools are available to optimize different tasks within the claims processing workflow. But for maximum efficiency, providers should look for solutions that work together within an integrated system. Using a single vendor makes it easier to manage data consistently and simplifies system-to-system interactions. A comprehensive claims management solution also creates a smoother user experience, for example, by allowing staff to check real-time insights within one dashboard, using one log-in. Experian Health's suite of healthcare claims management solutions connects each step in the claims workflow to speed up claims processing. For example, ClaimSource manages the entire claim cycle in a single, scalable online application that serves individual hospitals and physician practices through to large multi-facility health systems. It creates custom work queues and integrates electronic remittance data directly, to allow staff to prioritize high-impact claims and speed up reimbursement. 2. It saves staff time and resources Outdated and clumsy processes can contribute to staff burnout, poor performance and difficulties attracting and retaining top talent, even more so as patient volumes return to pre-pandemic levels. By removing many time-wasting manual tasks, automated claims processing allows staff to use their time more productively. It's particularly important amidst ongoing staffing shortages, which put additional strain on existing staff. Some of the most time-consuming manual activities occur in the prior authorization workflow. Prior authorizations are also a common cause of claim denials. Because payer requirements around prior authorizations change frequently, staff must painstakingly check each payer's website before submitting authorization requests to ensure that the necessary documentation is in place. Once submitted, they must log in to different payer portals to track progress. According to the American Medical Association, some physician practices spend more than two full days processing prior authorizations each week. But with automated prior authorizations, staff can prevent delays and denials. Online prior authorizations automate inquiries and submissions without the need for user intervention, instead drawing on payer data that are already updated and stored in the system. It auto-fills the necessary information and flags where manual intervention is required. It can initiate more authorizations in less time, and guide staff to the highest-priority tasks using dynamic, exception-based work queues. By reducing the error rate, automation also facilitates faster claims processing, which means payments can be processed and issued more quickly. 3. Automation generates more accurate and actionable insights Automation doesn't just save time; it also gives staff greater clarity and control over the claims process. Automated digital solutions facilitate more reliable data management to reduce errors, and generate real-time insights based on accurate information. A large proportion of claims are denied because patient information doesn't match the payer's records. This can be easily avoided using robust electronic medical records that hold data in standardized formats and automatically populate forms with the correct information. Electronic data management also gives staff richer and more reliable insights, by pulling together all the information they need into a single, accessible interface. Using an automated tracker such as Denial Workflow Manager makes it easy for staff to monitor claims, denials and remittances in one place. Not only does it track denials, holds, suspends, zero pays and appeals, but it also provides detailed analysis to help root out the causes of denials, so they can be avoided in the future. Staff can immediately see which claims need attention and resolve them much more quickly, as opposed to using manual processes. Enhanced Claim Status complements Denial Workflow Manager by automatically generating work lists for staff, complete with actionable data to help them check off the tasks quickly and accurately. The software sends automated status requests based on each payer's claims adjudication timeline, to see if claims are pending, denied, returned-to-provider or zero-pay transactions. This takes place before the Electronic Remittance Advice and Explanation of Benefits are processed, so staff can respond quickly and avoid unnecessary denials or delays. 4. Faster claims processing equals faster payment According to the Council for Affordable Quality Healthcare (CAQH), the time saved by switching from manual to electronic claims processing could save the medical industry up to $1.7 billion each year. The increase in accuracy leads to more first-time pass-through rates and optimized decision-making around which claims to rework. While automation requires some upfront investment, the output tips the balance in favor of faster, higher reimbursements. Experian Health's Claim Scrubber solution is one example of how automated claims processing can reduce undercharges and denials, optimize staff time and improve cash flow. This program reviews each pre-billed claim, line-by-line, to check that coding details are accurate. It then applies general and payer-specific edits and verifies that the claim is free of errors before it's submitted to the payer or clearinghouse. As a result, more claims are correct – and therefore paid – the first time, and staff can spend less time chasing old accounts receivable. Case study: Read how Summit Medical Group Oregon – Bend Memorial Clinic reduced A/R days and volume by 15%, and achieved a 92% clean claims rate with Claim Scrubber and Enhanced Claim Status. 5. Automation can transform the patient experience Getting claims right the first time starts at the beginning of the patient journey. A digital patient access experience is more convenient and satisfying for patients and helps prevent errors that can lead to denied claims later. Patient contact information can be automatically pre-filled so the patient can check for errors. If a patient adds new data when they're scheduling or registering for care, that information can be automatically checked against the data already on file, and flagged if there are inconsistencies. Further along, the efficiencies afforded by claim process automation mean patients don't have to wait so long for confirmation that their medical expenses have been handled. Or, if they have an out-of-pocket amount to pay, they'll get clarity about their financial responsibility much sooner. Patient portals are a great tool for helping patients track claims when and where it suits them, rather than having to wait to speak to a call center agent. And by making the claims process more efficient, automation also releases staff from time-consuming repetitive administrative tasks so they're free to support patients with more complex queries. Automation can elevate the customer experience with personalized communications and simplified transactions, from patient access to patient payments. Transitioning to automated claims management As the volume and complexity of claims to be processed increases, providers need to find ways to manage the workload, alleviate pressure on staff and prevent unnecessary revenue leakage. Working with a trusted vendor can ease the transition to automation and maximize potential cost savings. Experian Health provides industry-leading software solutions to improve healthcare claims and denials management so that more claims are clean the first time. In fact, Experian Health was voted as the top claims vendor for hospitals in the 2022 Black Book vendor survey, for the second year in a row. Find out more about how Experian Health's suite of healthcare claims management products can help providers reduce denials, rebilling and drive up reimbursements with automated, clean and data-driven claims processing.

New data reveals that the number of healthcare data breaches continues to climb, causing financial and reputational damage to healthcare providers. HIPAA Journal reported 692 large healthcare data breaches between July 2021 and June 2022 that exposed the records of over 42 million individuals. The number of records breached in June 2022 was more than 65% higher than the monthly average over the previous year, highlighting the need for providers to stay on top of their game when it comes to protecting patient data. In a recent conversation with PYMNTS, Chris Wild, Experian Health’s Vice President of Adjacent Markets and Consumer Engagement, discussed the consequences of healthcare data breaches and set out the key steps providers should take to prevent and resolve security incidents. Compromised patient records send financial and reputational costs soaring IBM reports that financial damages resulting from data breaches have reached a 12-year high, with the average breach in healthcare costing $10.1 million, up nearly $1 million since 2020. Wild notes that this includes a huge range of costs, from HIPAA fines to operational costs to curb and resolve breaches: “The cost of dealing with a breach is enormous. There’s anything from penalties of $100 per incident to $1.5 million per year. You’ve got reconciliation costs – trying to patch the holes in technology stacks and things like that. You’ve also got inbound phone calls from concerned patients who’ve just heard about a breach and want to know if it impacts them.” But Wild says that beyond HIPAA fines and operational expenses, the greatest cost is repairing the reputational damage of breaching patient trust: “the reputational cost is enormous because once you lose a patient, you lose a patient.” Wild suggests a two-pronged approach to mitigate the risk and impact of a healthcare data breach that focuses on prevention and preparation. Protecting patient identities to deliver a satisfying and secure consumer experience  An unfortunate side effect of the accelerated adoption of digital health solutions during the pandemic was that it opened the door to new methods of medical crime and fraud. Patients interact with their data electronically more often, thus increasing their vulnerability to cyber-criminal attacks. Preventing infiltration by bad actors before they occur should be the priority. In the past, efforts to secure a patient’s identity have relied on personal security questions, considered unanswerable by anyone but the patient. However, Wild says that asking for past addresses and details of previous living arrangements may no longer be the gold standard: “We’re finding that this is a little bit passé now. There’s a lot more that goes into identifying somebody, and that goes along with improving security, but it also improves the patient experience. There’s always been a balance between trying to make sure that data is secure on the one hand, but also make sure that it’s easy to access on the other.” To this end, providers should look for patient engagement solutions that deliver a flexible, convenient and consumer-friendly patient experience, while ensuring that patient data is secure. Wild suggests a few specific strategies, such as monitoring device ID and validating the identification documents used during patient registration: “When you have your cell phone or your tablet or your laptop, or your computer, or even your voice assistant devices, they all have a device ID. We keep track of those and see which ones are being naughty, which ones are being nice. We can start to ramp up when we see a naughty device acting naughty. But also think about things like document verification, validating that a driver’s license being shown to a registrar is actually a real driver’s license, or things of that nature.” A multi-layered approach to securing patient portals and other digital patient access tools will ensure there is no single point of vulnerability. Experian Health’s patient portal security solutions with Precise ID include a range of protections, including two-factor sign-in authentication, device intelligence and additional checks on risky requests to proactively secure patient identities. Each element protects against a specific type of threat, building up defensive depth to thwart attempts to breach patient data. Responding quickly in the event of a healthcare data breach Prevention only goes so far, though. Evidence suggests that most healthcare providers will be hit by a data breach at some point. Wild suggests that regular “fire drills” can help ensure that everyone in the organization knows how to respond, should the worst happen: “For a healthcare data breach or any sort of misappropriation of patient or member data, you want to make sure you’re keeping things safe, keeping things secure, and make sure that all of the associated people know what to do.” Wild says this must include front desk staff who will be answering phones from worried patients, through to marketing teams who will need to put out proactive messages about what happened and how it will be dealt with. How a provider responds may have an even greater impact on their reputation and patient loyalty than the breach itself. All of this can be pulled together in a data breach response plan, which sets out exactly what needs to be done and by whom, to help organizations avoid missteps in the aftermath of a breach. Experian Health’s Reserved ResponseTM program can help healthcare organizations put together a data breach preparedness plan in as little as three days. The program is based on 17 years of real-world experience dealing with data breaches and has evolved as security threats and consequences have increased. The program offers providers guides, templates, checklists and service-level agreements to guarantee manpower, infrastructure and response readiness at the most crucial moments. As the uptake of patient portals and other digital patient access solutions accelerates, finding the right data security partner to help navigate the unprecedented threats and consequences will be essential. Watch the full interview with Chris Wild and find out more about how Experian Health helps healthcare providers protect patient identities to prevent healthcare data breaches.

On July 28, the US House of Representatives voted in favor of extending Medicare telehealth flexibilities after the COVID-19 public health emergency ends. If enacted, the Advancing Telehealth Beyond COVID-19 Act will allow beneficiaries to continue to access telehealth services at any site, including their home, until December 31, 2024. Coverage for a wider list of telehealth practitioners, delivery at specific clinics, audio-only telehealth, and remote behavioral health and hospice care would also continue. After a quick implementation period at the start of the pandemic, providers spent the last two years refining telehealth delivery. However, a question mark remained about telehealth’s post-pandemic prospects. The new legislation offers welcome certainty around reimbursement, at least until December 2024. More significantly, it’s further confirmation that telehealth is likely to become a permanent fixture in modern healthcare delivery. What does that mean for providers? Telehealth is here to stay Throughout the pandemic, remote and virtual care proved an effective way for providers to maintain relatively stable service delivery and limit gaps in care. It even helped to tackle inequitable access to care by making it easier for rural and underserved communities to speak to their doctor. Now, patients and providers alike are familiar with the benefits of telehealth. It’s an expected component of the overall healthcare experience. For the American Telehealth Association, the vote is “a significant step forward in providing much-needed stability in access to care for millions of Americans… We cannot allow patients to lose access to telehealth post-pandemic, and this bill will provide stability through 2024, while giving Congress time to address how to make the policies permanent.” As telehealth is gradually stitched into the fabric of the US healthcare system, providers should consider the following three actions to maximize the opportunities that come with delivering virtual and remote care: 1) Review the digital patient journey and increase telehealth access Telehealth is more than just a video visit – a truly virtual patient care experience starts from the moment the patient books their appointment all the way through to patient billing. Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they’d consider changing healthcare providers to one that offers a patient portal. Prioritizing the use of digital channels could therefore boost patient attraction and retention, as well as efficiency and productivity. Integrating telehealth platforms with online scheduling software means patients can choose how and when to book their appointment, and appointment options are synced with physician calendars for maximum efficiency. Similarly, providers can ease friction when patients are registering for a telehealth visit by offering digital, automated and mobile-friendly registration. 2) Prioritize personalized patient outreach and engagement While many patients are now familiar with telehealth services, many may not be aware that it’s an option or may be unsure of how it works. Patient engagement strategies are essential in communicating to patients that telehealth services are available. By providing clear information about how the visit will work, how to use the technology and how to prepare, providers can help patients understand the process more clearly so they get the most out of their visit. This is especially important for patients who may be unable to attend in-person visits (e.g., due to location, disability, or lack of transportation or childcare). Telemedicine helps these patients take a more active role in their health and healthcare journey, in turn closing gaps in care. It also creates opportunities for remote patients to access experts that they’d otherwise be unable to see. Consumer data helps providers build patient engagement and outreach strategies based on reliable demographic, behavioral, psychographic and financial information. As telehealth services grow, a tool like ConsumerView enables providers to segment, identify and communicate with different audiences so that patients receive the most relevant message at the most useful time. 3) Explore automation for efficient telehealth billing Keeping track of telehealth reimbursement regulations has been one of the key challenges for providers as telehealth services have expanded. Flexibility reduced some of the barriers to scaling telehealth services, but did leave the door open to variation in payer requirements, coding changes and geographical coverage. The new legislation would maintain the status quo for a while longer. But looking ahead, any further changes to telehealth reimbursement rules, combined with greater telehealth utilization, could leave providers with an administrative mess to clear up if they don’t have robust processes in place. Those that utilize claims management and billing tools now will be best placed to manage what may follow. Automation can ease the burden in several ways. For example, with Coverage Discovery and eligibility verification solutions, providers and patients can confirm coverage eligibility early, which will speed up collections further down the line. Another option is to use automated healthcare claims management software to ensure every telehealth claim is submitted correctly the first time. With Experian Health’s customization function, telehealth alerts can be automatically checked so providers know whether the patient is covered for virtual care. As telehealth services gain a permanent place in the healthcare ecosystem, providers should act now to optimize patient-facing services and back-end processes. Failure to do so could cause patients to look elsewhere for the healthcare experience they desire and lead to lost revenue opportunities. Contact Experian Health today to discover how data-driven insights and automation can help providers bolster their telehealth offerings to maximize reimbursements.

As the COVID-19 pandemic collides with another winter flu season, patient volumes are likely to climb – which could leave traditional patient registration processes crumbling under the pressure. Healthcare providers should identify opportunities to improve the patient registration process and guard against bottlenecks in patient access over the coming months. Streamlined patient intake isn’t just about alleviating pressure – it lays the foundations for the entire patient journey. The question for providers is whether this first touchpoint signals efficiency, compassion and convenience, or hints at errors and delays to come. The answer to that question will most likely depend on the organization’s success in delivering a digital patient access experience. Patients don’t want a stack of papers to fill out by hand in the waiting room. They don’t want to make lengthy phone calls at inflexible times. They want frictionless processes, user-friendly tools, and quick, accurate information. Pre-registration should demand as little of their attention as possible. For this reason, automated and digital patient registration solutions are likely to be differentiators for healthcare providers. Here are 5 ways to improve the patient registration process before flu season hits: 1. Offer patients convenience and choice with virtual registration options More than 8 in 10 providers say their patients prefer an online registration experience, according to Experian Health’s 2021 State of Patient Access 2.0 survey. In a more recent study, Experian Health and PYMNTS found that a third of patients filled out registration forms at home. It’s no wonder: completing forms in the waiting room is time-consuming, inconvenient, and exposes patients to the risk of infection. With Registration Accelerator, providers can offer a simple text-to-mobile experience so patients can begin registration with a single click. Registration forms can be filled out from the comfort and convenience of home, where patients are more likely to have insurance details to hand. Alternatively, some patients may choose to do this in their car before their appointment, which reduces waiting room traffic. Not only does this meet the expectations of Gen C healthcare consumers, but it also helps patients prepare for their appointments, so they’re more likely to remain actively engaged in their care. 2. Increase efficiency and reduce delays with streamlined workflows Automated patient intake also alleviates the administrative burden for busy staff. Manual patient registration incurs high labor costs, and as patient numbers increase, patient access staff cannot afford to lose time to inefficient paper-based systems. Self-service options such as patient portals allow patients to take care of more of these tasks themselves, freeing staff to focus their efforts on patients who need extra help. Automated reminders to complete forms and schedule appointments also help to reduce delays, in turn creating more efficient workflows. An added benefit of software-based processes is the ability to generate detailed insights and performance reports, which eliminates redundant tasks and flags up opportunities for further improvement. 3. Avoid costly errors with integrated data management systems One of the biggest advantages of an automated registration solution is that it can be integrated with other data management systems, including hospital information systems, electronic medical records, and project management systems. This means that staff no longer need to input the same data multiple times into different systems. It saves time and avoids errors that lead to delayed reimbursement. When patient data is pre-filled and checked automatically against information on file, there’s a far lower risk of error than in situations where a patient or staff member writes it out by hand or communicates it verbally across a noisy reception desk. Reimbursement need not be delayed while errors are found and fixed. This is the thinking behind eCare NEXT®, which integrates and automates patient access activities within a single platform. When Martin Luther King Jr Community Hospital integrated eCare NEXT® with Cerner, they saw a huge improvement in their registration processes, saving two to three minutes on more than half of their registrations. For healthcare organizations grappling with increasing registrations this winter, those minutes add up. 4. Accelerate payments from patients and payers to improve the patient registration process According to the State of Patient Access 2.0 survey, 88% of providers said they were planning to invest in patient intake capabilities in 2021, up 15% on the previous year. While the shift to online and virtual patient registration was undoubtedly motivated by the pandemic, the opportunity to accelerate reimbursements and reinforce the revenue cycle was another major driver. Registration Accelerator works alongside Patient Financial Advisor so patients can get accurate, personalized pre-service price estimates and payment management options through a single unified experience. Providers may also consider running repeated coverage checks from the moment a patient registers, to find any missing or forgotten coverage. If coverage is found, claims can be submitted promptly to payers, further increasing the options and likelihood for reimbursement. 5. Reduce no-shows and increase bookings with automated scheduling Finally, as service utilization increases over the winter months, providers will want to ensure that every possible appointment slot is filled. Integrating registration solutions with digital patient scheduling tools can help to reduce no-shows and improve the patient registration process. Patient Scheduling is a multi-channel platform for guided search and allows 24/7 access to scheduling options, which makes it easier for patients to book appointments. Automated reminders can be sent to patients so they don’t miss their appointments, with easy links to reschedule if they can no longer attend. These tools can be customized to meet the specific needs of the organization’s workflows, to increase the number of bookings and reduce the number of patients lost to follow-up. Find out more about how Experian Health’s digital patient access solutions can help improve the patient registration process ahead of the busy winter period.

As inflation puts the squeeze on families and individuals, healthcare providers have an opportunity to reimagine the patient financial experience so that medical bills put less stress on a household’s finances. Consumer-friendly changes might include providing estimates, clarifying benefits statements, offering payment plans, providing digital tools to make payments more convenient and offering more payment options. Not only would this help patients manage their medical bills so they feel more in control of their finances, but it would also help ensure that healthcare providers get paid faster and more reliably. Treating patients more like customers might actually boost the bottom line. In fact, a recent study from Experian and PYMNTS revealed that 6 out of 10 patients who paid out-of-pocket healthcare costs and received either an inaccurate cost estimate or an unexpected bill would switch healthcare providers for a better payment experience. “The Healthcare Conundrum: The Impact of Unexpected Patient Costs on Care,” a new report by Experian Health and PYMNTS, surveyed 2,483 consumers to learn about the effects of rising healthcare costs and unexpected medical bills on patient care and satisfaction. The financial challenges for patients Patients have been forced to assume a greater financial burden for healthcare payments through the prevalence of high-deductible healthcare plans. One benefits survey found that 58% of covered workers have at least a $1,000 deductible for single coverage. And due to limited payment options for managing medical costs, many consumers get strapped with large medical debt. More than half of Americans have at least $1,000 in medical debt and more than two-thirds of Americans under 65 report that they struggle with the cost of healthcare. Some consumers even opt to delay or forego medical care because of the cost. The healthcare industry has invested billions of dollars in technology and services that empower patients to play a more active role in the clinical side of their health journeys. Now, providers have an opportunity to do the same with the financial side of healthcare, so patients are empowered to better manage their health costs. 3 investments for a better patient financial experience Experian Health’s State of Patient Access 2.0 survey showed that patients want transparent healthcare pricing, payment plans and support, and faster and more convenient ways to pay their medical bills. “Giving patients transparency and payment options can improve the patient experience,” says Liz Serie, Senior Director of Product Management at Experian Health. She explains that it’s important for providers to improve the financial experience because it will benefit each patient’s overall health journey, increase the likelihood that patients will pay their medical bills, and help build patient loyalty as consumers prefer providers that offer convenient financial tools for patient payments. Experian Health has a suite of tools and services that can help providers improve these aspects of the financial side of healthcare. If providers make these strategic investments in the patient financial experience, they can both grow revenue and increase patient satisfaction. Investment 1: Price transparency Financial transparency is a major issue in healthcare, which results in unexpected or unexpectedly large medical bills. Data from Experian and PYMNTS revealed that in the past 12 months, 43% of patients who received inaccurate cost estimates and 40% of those who received an unexpected bill spent more than they could afford. If providers can offer more price transparency, it will help patients avoid getting stuck with inaccurate, confusing, or nonexistent estimates for their health costs. Tools like Patient Payment Estimates and Patient Financial Advisor can deliver clear estimates to a patient’s mobile device so they can be better informed about their health costs – and be better prepared to manage them. Patient Estimates uses real-time insurance status, contract rates, and provider pricing so the patient gets an accurate breakdown of a pricing estimate on the front-end of their care. This will allow patients to focus on the care they need instead of stressing about price uncertainty. These tools also offer convenient ways for patients to pay their medical bills so they can manage their financial obligations. Investment 2: Customized payment options Consumers expect financing options for larger purchases like cars and appliances, so healthcare providers should consider offering the same.  Personalized payment plans can help patients manage and pay their health bills. PatientSimple identifies the best financial pathway for each individual patient and offers an easy-to-use, self-service portal that helps them navigate that path. Patients can also use this tool to store payment information, set up payment plans, and apply for charity care. Consumers also want digital payment options that give them a fast, flexible, and secure way to make payments. Many consumers report that the pandemic has changed how they prefer to pay for goods and services. They want more contactless options, online portals, and mobile-friendly systems. Experian’s Patient Payment Solutions modernize patient payments through mobile-optimized, self-service options that make it easier and simpler for patients to pay their health bills in whichever way they prefer. Investment 3: Data-driven financial insights Healthcare providers can use data-driven tools like Patient Financial Clearance and Collections Optimization Manager to determine which patients have the financial capacity to pay their medical bills – and which patients might need financial assistance. By tailoring payment plans to each individual patient, providers can improve the financial experience and increase the efficiency and productivity of collections. Consumers have shown that they want convenient and customized payment options for all their purchases – healthcare included. To meet that expectation, providers can leverage technology, data, and analytics, creating the best possible patient payment experiences and improving their own bottom lines. Learn more about Experian Health can help healthcare organizations reimagine the patient financial experience with digital tools and solutions.