The Appropriate Use Criteria (AUC) program is due to come into full effect in January 2023 at the earliest. The program was established by the Centers for Medicare and Medicaid Services (CMS) to help providers order the most appropriate diagnostic imaging services. Failure to comply may result in claims denials. Any provider that offers these services to Medicare beneficiaries should amend their clinical and revenue cycle workflows now, to avoid payment penalties when the AUC testing period comes to an end. This article sets out what providers can do to learn, test and prepare for the AUC program, and what Experian Health is doing to help healthcare providers manage these changes and minimize the risk of denied claims. What is the Appropriate Use Criteria program? The AUC program was created through the Protecting Access to Medicare Act of 2014 to help ensure that diagnostic imaging services would only be provided where medically necessary. No one would argue against evidence-based care. However, accessing that evidence can be challenging. Easy-access online tools are intended to make this easier. They have also been shown to reduce the overutilization of high-risk, high-cost imaging services. Under the program, any time a physician (or a member of their clinical staff) wants to order imaging services such as magnetic resonance imaging (MRI) or computed tomography (CT) for certain Medicare patients, they’ll need to consult an electronic Clinical Decision Support Mechanism (CDSM). This is especially important in an academic teaching environment. This online portal will check the patient’s electronic health record (EHR) and determine whether the order adheres to AUC or not, or whether the AUC consulted was not applicable. After consulting the CDSM, the ordering physician will need to include the following data on the order they send to the imaging services provider: the CDSM they consulted the ordering provider’s National Provider Identifier whether the service adhered to the applicable AUC or not, or whether no criteria in the CDSM were applicable to the patient’s clinical situation. Any ordering professionals deemed to be outliers will be required to seek prior authorization. When the program is fully implemented, imaging service providers will need to ensure they have a certificate of compliance to secure reimbursement. Who will be affected by the AUC program? The program applies to any provider that orders advanced diagnostic imaging services that are delivered in physician’s offices, hospital outpatient departments, ambulatory surgical centers (ASCs) or independent diagnostic testing facilities. It applies to those that are paid under the Medicare physician fee schedule, hospital outpatient prospective payment system or ASC payment system. It does not apply to Medicare Advantage beneficiaries. Emergencies, inpatient services and certain hardship exceptions are exempt. If any of these exceptions apply, the ordering physician must record them on the claim using the appropriate modifier code. When do providers need to implement it? CMS confirmed that there will be no payment consequences for failing to include AUC data until the later of January 2023 or the declared end of the COVID-19 public health emergency. In the meantime, providers are encouraged to implement the program on a voluntary basis, which will help identify pinch points in the claims management workflow. Claims submitted before full implementation may still be subject to denial, so it’s worth getting the process right now to avoid unnecessary rework later. How can providers “learn, test and prepare” for the AUC program? Healthcare organizations that may be affected by the AUC mandate should consider the following actions to ensure they are fully prepared by the time the program is fully implemented: Check the AUC program requirements and identify which service lines and vendors will be affected. Choose an appropriate Medicare-approved CDSM that closely matches existing EHR and claims management processes. Most EHR vendors will recommend a CDSM that fits seamlessly with their solution. CMS has also provided a list of certified CDSMs, which includes free options. However, these operate as stand-alone systems that will be more challenging to integrate with existing workflows. Communicate changes to staff. Ensure all referring and rendering providers are aware of and trained on the requirements and encourage dialogue to clarify new ways of working. Consider the impact on claims management teams, and ensure staff are trained on the new requirements. Healthcare Common Procedure Coding System G-codes and modifiers must be reported in claims alongside primary and secondary diagnosis and procedure codes. Are staff aware of the new codes? Are additional staff needed to process claims and potential rework that may be required after the AUC program is implemented? Build in time for review, to check that new processes are compliant. Ideally, the CDSM solution will include reporting functions to monitor progress and identify potential outliers that may be subject to prior authorizations later. If the furnishing provider is different from the ordering provider, the furnishing provider should have a workflow to confirm AUC adherence. How can digital tools and automation help providers ensure compliance with Appropriate Use Criteria? While the goal of the AUC program is to improve patient care and help manage the cost to the public purse, there will be an administrative burden for staff. The growing volume and complexity of claims overrule any attempt to manage this manually. Instead, healthcare organizations should look at automating the compliance process to ensure accuracy, prevent denied claims and reduce staff costs. To help healthcare providers manage these changes, Experian Health enhanced the Medical Necessity application to generate informational alerts when a procedure needs to adhere to AUC or prior authorization for Medicare patients. Users will be able to use this alert as a sign to check the AUC has been adhered to. These tools also fit well with Claim Scrubber, which reviews every line of each claim to verify that it’s coded correctly and isn’t missing any vital information, before being submitted. Claim Scrubber has also been enhanced to incorporate billing modifiers that will help with overall compliance requirements under the AUC rules. Preparing for what’s to come Access to medically necessary services is at the heart of evidence-based care. However, in promoting this, the Appropriate Use Criteria program creates additional tasks for staff that need to be understood and managed efficiently. While there are currently no penalties for non-compliance, providers should use the testing period to proactively implement new processes to determine their efficacy. As healthcare regulation continues to evolve, healthcare organizations should take a holistic approach to the exchange of information between clinical decision-makers, service providers and payers to lay the groundwork for consistent, accurate and reliable claims. Find out more about how Experian Health’s Medical Necessity and Claim Scrubber solutions support the claims management process and help healthcare organizations adhere to the Appropriate Use Criteria program.

Patient experience may not be the first consideration that comes to mind when you're looking to improve revenue cycle management (RCM). However, a positive patient experience can benefit RCM. It can make the complicated process of understanding and managing healthcare finances simpler and more seamless for patients—and facilitate an easy-to-navigate continuum of care that includes RCM. Financial transparency plays a significant role in building trust and confidence between patient and provider. Patients who may find it difficult to understand medical billing and health insurance coverage—and who are paying more out-of-pocket costs thanks to high-deductible health plans—appreciate accurate estimates and a range of convenient payment options. By optimizing back-end claims, billing, payment and collections processes, providers free up staff to provide individualized help to patients who need it. Strategies to bolster patient experience and RCM Patients who have grown accustomed to using digital platforms for everything from online shopping to food delivery, travel, managing finances and entertainment gravitate toward digital tools and expect a high level of functionality. In a Salesforce survey of 15,000 consumers, 68% of respondents said their expectations of companies' digital capabilities increased after COVID-19 drove more of their activity online. Providing a superior digital experience is now synonymous with good service, but healthcare is lagging behind other service sectors. For providers, automation and data analytics can streamline workflows and improve efficiencies. These factors are critical as staff find themselves under increasing pressure to provide accurate patient estimates upfront and to submit claims accurately to reduce denials. How can providers use the patient experience to improve RCM? Here are a few areas of focus to consider: 1. Offer consumer-friendly front-end technology Patients are looking for seamless digital experiences, where they are empowered to search out what they want, choose from a menu of options and pay effortlessly online. In a healthcare setting, they want to find and schedule their own appointments quickly. Providing new and existing patients with 24/7 mobile access to online patient scheduling is critical to early engagement. In fact, a new report from Experian Health and PYMNTS revealed that 61% of patients interested in using patient portals say they would switch to a healthcare provider that has one. Providing patients with an accurate estimate they can review in advance improves transparency and builds trust. This allows patients to ask questions and make decisions about how to pay on their own time and without pressure. Pre-appointment estimates might also offer patients the opportunity to pay conveniently online before their appointments or at the point of service, minimizing the need for post-treatment collections and reducing RCM costs. 2. Simplify and automate in-office technology Automation can boost the experience on both sides of the front desk. Automated processes simplify patient-facing tasks like registration and check-in while making back-office operations like data entry and authorizations more efficient. “When a patient submits photos of their insurance card and identification, software scrapes that information and inputs it into the system,” Serie explains. “This process is more convenient for the patient, faster and more efficient for staff, and reduces the potential for human error.” As healthcare providers continue to experience staffing shortages, automated systems can offer greater workplace flexibility. That's helpful for providers that need to flex their resources, but also for employees who want more options on where and when they work. 3. Provide price transparency and financial information to improve the patient experience In a Policygenius consumer survey, 26% of respondents said they have avoided care or treatment because they were unsure what their insurance covers. Patients might be forgiven for feeling confused and frustrated – healthcare bills are not always patient-centric. In fact, many consumers report a low level of insurance literacy and, unless told, don't know in advance what medical procedures are likely to cost. At the same time, out-of-pocket costs are rising, raising the stakes and increasing the likelihood that medical bills will pose a significant financial challenge. Outlining estimated costs prior to service can help patients understand their expected out-of-pocket payments. Accurate patient payment estimates take away some of the sticker shock and give patients an opportunity to discuss coverage with their insurance companies, choose the right payment methods, or arrange for payment plans before treatment happens. 4. Allow for online bill payments Frictionless payments are now the norm, online and in-app. Experian Health's PatientSimple solution offers healthcare organizations a suite of tools to simplify payment. Using a healthcare-specific algorithm, PatientSimple provides personalized, data-driven insights that help providers deliver the right messaging and payment options, including: Price estimates based on insurance coverage and payer's negotiated rates Guest payment option for patients who don't want to set up an account Online payments and payment plans E-statements, online account access and email payment reminders Qualification for financial assistance A smoother path to payment increases the chances that patients will pay pre-appointment or at the point of service. By offering patients more and better payment options providers can increase up-front revenue and reduce the need for collections. 5. Enable self-service Frictionless payments are just one facet of helping patients help themselves. Enabling the tools that create a “digital front door”—including the ability for patients to register and check-in online, access a virtual waiting room and make “contactless” payments—can boost engagement and give patients greater choice, control and convenience. By mapping a patient journey that flows seamlessly between virtual and in-person interactions, providers can set the stage for receiving payment earlier in the process. This can also help with outreach to patients post-care for follow-up and payment, if necessary. 6. Ensure coding and billing accuracy Clear, accurate patient billing is the goal, but keeping up with changes across multiple payers is an ongoing challenge for healthcare providers. New products, mergers and acquisitions, policy and procedure changes all create the potential for errors, denials, delay and lost revenue. Experian Health's Payer Alerts helps notify providers of payer policy and procedural changes with a daily digest email and an online portal. A simplified estimate process with fewer revisions streamlines the RCM process; it also helps patients avoid confusion, which degrades the patient experience and may cause patients to delay payment. 7. Optimize bill collections Collections can be one of the most difficult parts of healthcare RCM. On the patient side, post-treatment collections feel like a hassle; they may also become a source of significant financial problems. For providers, collections can be costly and time-consuming. Optimizing collections with automation and data analytics can streamline the process and improve outcomes. Experian Health's Collections Optimization Manager uses specialized scoring algorithms to segment and prioritizes accounts based on the likelihood they'll be able to pay. Automated billing and outreach make collections less onerous for staff, while automatic updates keep accounts and communications current. For patients, providing convenient digital payment options takes some of the friction out of the payment experience and removes at least one barrier to bringing an account current. Patient experience and RCM go hand in hand Improving healthcare RCM is certainly not the only reason to work on improving the patient experience. Enhancing the patient journey across the care spectrum can help providers engage new and existing patients, offer the digital tools and seamless experiences they've come to expect, and reduce their anxieties over medical costs. At the same time, using RCM solutions to bolster the patient experience means new efficiencies for staff and, along with this, expanded opportunities for work flexibility and greater success at managing the revenue cycle. Contact Experian Health to learn more about optimizing your patient experience and improving RCM at your organization.

Experian Health and PYMNTS recently collaborated to release a new report, "Accessing Healthcare: Easing Digital Frictions In The Patient Journey." Getting care through digital channels became a norm during the pandemic, and will continue post-pandemic. Digital-savvy consumers have come to expect seamless experiences; however, there are a few gaps that healthcare providers must continue to address. This report examines how consumers use digital healthcare channels, their pain points and how providers can address gaps to improve patient care and satisfaction. Check out some of the highlights below: To learn more about how consumers access healthcare services via digital methods, download the full report.

Inflation is giving the cost of healthcare a run for its money. The Consumer Price Index rose by 8.3% year-over-year in August 2022, compared to a rise of just 2.9% in the Health Care Price Index. However, slower price increases do not necessarily mean healthcare will get an easier ride than other businesses. Healthcare contracts are agreed in advance with government and commercial payers, so any effects of inflation could simply be delayed. How should providers factor such economic unpredictability into their revenue cycle management strategies? Healthcare is usually more resistant to wider economic shocks than other service sectors, so rising inflation doesn’t necessarily mean there’s an urgent need to change course. Providers are always working to maintain a healthy revenue cycle and will continue to do so now. That said, the lingering financial effects of the pandemic, staffing shortages and increasing operational costs mean that provider cash flow is sensitive to any added pressure. While there’s currently no sign that patient collections have been significantly affected by inflation yet, patients may assume that health costs will increase too, along with everything else. This might lead them to delay elective care, which could affect providers’ bottom lines. As non-COVID patient traffic slowly returns and state and federal aid ends, rising inflation presents an additional hurdle to providers’ financial health. Providers will need to tighten their patient collections process and safeguard their bottom line. Download the white paper to learn how inflation is impacting healthcare and get strategies to optimize collections and avoid revenue loss. Providers that want to bolster their revenue cycle against the potential impact of inflation should focus on increasing workforce efficiency to manage costs and mitigate the risk of deferred care, to maintain a steady inward cash flow. They’ll also want to be prepared for any potential shift in patient payment reliability that could occur if inflation persists. Automated solutions and self-service digital tools can help to solve these issues. Minimize workforce inefficiency with automation and self-service solutions Questions to consider: How can digital technology and automation improve efficiency and ease pressure on staff? Where can patient self-service solutions help reduce the need for staff input? Inflation is likely to hit providers hardest in relation to payroll expenses. Staffing shortages lead to increased costs as providers raise salaries to attract and retain new staff, pay overtime costs, and hire more temporary workers. Reduced purchasing power will only exacerbate these challenges. Automation and digital tools can help address staffing shortages and keep a lid on payroll costs by increasing efficiency in existing workflows. For example, digital technology can allow patients to take care of many administrative tasks themselves, thus reducing the demand for staff input. Online self-scheduling and registration allow patients to book appointments and fill out pre-service paperwork without taking up valuable staff time. These tools leverage data and automation to pre-fill patient information, which reduces the risk of costly errors and saves time for patients and staff. Further along in the patient journey, automated collections can eliminate much of the manual work that puts pressure on understaffed teams, while increasing the likelihood and speed of payment. Collections Optimization Manager helps increase workforce productivity to make better use of staff time and avoid unnecessary revenue loss. Advanced analytics are used to prioritize accounts by payment probability, which will be increasingly useful should ongoing inflation increase the risk of patient bills going unpaid. Consumer data helps identify the most appropriate communications method for each segment, so the right message can be sent at the right time to boost the chances of collecting a greater percentage of money owed. Automation also helps reduce staff costs to collect, while bumping up the amount of money that comes in the door. As hospital operations become more expensive on the whole, maximizing efficiency in collections is increasingly important. Maximize revenue by removing friction for patients worried about the cost of care Questions to consider: How can providers help patients better understand their bills? How can digital technology make it easier for patients to access and pay for care? The second step is to make sure that dollars keep coming in the door. Managing household bills can be challenging for patients, and there’s no suggestion that the rise in inflation during 2021 has added any new pressure to patients’ ability to pay for healthcare. Experian Health’s clients also continue to see very low levels of delinquency. However, despite pay raises, many consumers are worried that price inflation will overtake any increase in household income, especially as energy and food prices go up. They may decide to cancel or postpone elective care until they’re sure of their financial situation or move their medical bills to the bottom of their priority list. In reality, costs for patients haven’t increased, because of the delayed effect of inflation in healthcare. That’s why it would make more sense for patients to seek elective care sooner rather than later. Given reports of pricing concerns, providers should consider ways to reassure patients about their financial obligations and make sure they don’t miss out on the care they need. Here are some ways that providers can support their patients: Providers can help patients get a better understanding of their medical bills and payment options, by incorporating solutions that offer greater price transparency. Upfront patient estimates delivered directly to their mobile device, with links to appropriate payment plans and payment methods, can help them plan with confidence. This will help to reassure patients that prices have not increased drastically due to inflation, so they are dissuaded from deferring care. Finding missing or forgotten insurance coverage is another strategy to give patients certainty around how their bills will be covered. A tool such as Coverage Discovery can run repeated and automated checks for previously unknown government and commercial coverage, using multiple data sources. Self-service patient access and patient payment tools can help to reduce friction during scheduling, registration and billing, so patients see fewer reasons to postpone care. Liz Serie, Senior Director of Product Management at Experian Health, says, “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” - Liz Serie, Senior Director of Product Management Find out more about how Experian Health’s digital tools and solutions can help healthcare organizations create a financial safety net and protect their revenue cycle against the possible impact of inflation.

Healthcare isn’t known for its consumer-friendly payment processes and trails behind other service sectors when it comes to matching consumer preferences for convenience, choice and control. Is healthcare about to change and adjust to patient-centered payments? Healthcare still gets the most votes as the industry that makes payments the hardest, but it’s certainly evolving. In large part, this is a result of the pandemic. Providers were forced to modernize processes and embrace contactless technology that consumers are familiar with, from their purchasing experiences in retail, hospitality and banking. Consumer expectations for better payment tools were already there – the pandemic demanded the experience met the expectations. However, patient-centered payments is more than simply catering to consumer preferences. The quality of the healthcare payment experience can affect how and when patients receive care. If patients are worried about managing medical bills alongside their other household financial responsibilities, they may be tempted to delay or forego care. If making payments is time-consuming, they may put off dealing with bills. If their provider doesn’t offer convenient tools to help with financing, payment plans and mobile payments, patients may jump ship to a provider that does. Providers will need to overhaul their existing payment system and give consumers what they need or risk losing revenue and patient loyalty. So, where are the opportunities for providers to deliver a more patient-friendly payment experience? Experian Health’s State of Patient Access 2.0 survey showed that patients are looking for clear, transparent healthcare pricing, payment plans and support, as well as faster ways to pay. Simplifying the patient payment journey is key. Here are six ways providers can make healthcare payments easier and faster in 2022. Think like a consumer It’s likely consumerization of healthcare payments will take place in 2022. Providers must put themselves in the patients’ shoes and imagine the ideal payment experience – fast, flexible and secure. Jason Considine, Senior VP at Experian Health, says providers are already seeing the benefits of a digital-first approach that gives patients a variety of payment options. He notes, “In one of our surveys last year, 93% of providers said improving the patient experience is a top priority for them. We’re aware of the need to change and modernize payments.”Experian Health’s Patient Payment Solutions help providers simplify the patient's financial journey with self-service, mobile-optimized payment options. This allows consumers to manage their healthcare payments as easily as they pay for groceries. Give patients more mobile payment options As more health services are delivered in retail health clinics, such as CVS and Walgreens, providers must offer the same convenient digital payment options to remain competitive. More than half of consumers say the pandemic affected how they pay for healthcare. Contactless payments, mobile wallets and online portals have become popular choices. Peer-to-peer payments such as PayPal, Venmo and Google Pay also saw increases in usage in 2021. Forward-thinking providers are offering mobile payment solutions with tools such as Patient Financial Advisor, which allows patients to see estimated cost breakdowns and take advantage of payment plans. Provide a compassionate patient experience with automated reminders and prompts Navigating healthcare payments can be stressful for patients. As a result, they’re more likely to choose a provider that offers a compassionate experience. An integrated payment solution can act as a “financial concierge” for patients, guiding them through the payment experience with appropriate prompts and reminders, through their preferred communication channels. Patient Outreach solutions help patients stay organized with timely bill reminders, self-pay options and automated text and voice messages. Consumer data supports these tools by giving providers insights about a patient’s ability to pay, so they can engage in supportive financial conversations to help the patient decide on their next step. Offer transparent pricing and upfront estimates Experian Health’s State of Patient Access 2.0 survey showed that price transparency had improved considerably between 2020 and 2021, and remains important to consumers. Demand for healthcare price transparency will continue to grow, so providers must keep pace with developments. Giving patients an accurate cost breakdown straight to their mobile device means they can pay faster and more efficiently. Patient Payment Estimates and Patient Financial Advisor work together to help patients understand their financial responsibility. This can help them plan for upcoming bills and pay immediately if they choose. Patients get a pre-service, personalized pricing estimate based on real-time insurance status, payer contracted rates and provider pricing. Use data to prescribe the right financial pathway Not all patients are able to clear their entire bill in one payment. Personalized payment plans are an ideal way to help patients manage their balances and apply for charity assistance if necessary. PatientSimple is a consumer-friendly self-service portal that allows patients to generate pricing estimates, figure out pricing plans, and store cards securely on file, all in one place. Not only does this eliminate much of the confusion and frustration that causes negative healthcare experiences, but it also helps increase patient payments and reduce providers’ time and cost to collect. Run repeated coverage checks to give patients financial certainty Jason Considine notes that “patient populations shifted dramatically during the pandemic, with many individuals losing jobs, finding new jobs, and moving around the country. Their ability to pay has also shifted, so providers are going to need to adopt tools and technologies that help them validate and understand each patient’s insurance coverage.” Solutions like Coverage Discovery can help providers run checks throughout the entire patient journey to find missing or forgotten coverage. This gives patients certainty that their bills are covered and helps providers collect faster. Other tools, such as Collections Optimization Manager, can help providers adopt a targeted collections strategy and segment patient accounts based on propensity to pay. Ultimately, getting paid faster comes down to creating the best possible patient payment experience. The more compassionate, convenient and flexible this experience, the easier it will be for patients to pay and the more likely it will be that bills are settled in full. Find out more about how Experian Health’s patient-centered payments solutions can help providers increase patient collections in 2022.

Solving the patient identity problem and ensuring that each patient record is accurate and airtight is a top priority. Healthcare providers want to be 100% confident in answering “yes” to the following questions: Is the patient who they say they are? Is the right medication being administered to the right person? Is the correct bill being sent to the patient’s current address? By validating patient identities, providers can secure patient trust, deliver high-quality care, and avoid losing revenue to identity errors and fraud. Unfortunately, patient identity management is only becoming more complex. While telehealth and remote patient access are opening healthcare’s digital front door to meet changing consumer needs and expectations, a mountain of sensitive patient data is piling up. This data is a gold mine for fraudsters who steal and sell patients’ personal information or use it to access services and prescriptions without paying. It’s distressing for patients and creates a major financial and administrative burden for healthcare staff. A nationwide patient identification system may still be some way off. However, providers can optimize patient matching in their own health systems by working to reduce vulnerabilities and adopting cutting-edge interoperable patient matching technology. Better patient matching means better patient care and protected profits The human cost of incorrect, incomplete or outdated patient medical records is significant. Patients could be given the wrong medication or diagnostic procedures. Allergy information can be missed. Patient test results can be mislabeled or mixed up. In Experian Health’s State of Patient Access 2.0 survey, almost half of providers said inaccurate and incomplete patient data was an obstacle to proactive follow-up, which could cause gaps in care and avoidable complications – which are critical to value-based care compensation. Duplicate and mismatched patient records also create massive inefficiencies that can threaten an organization’s financial health too. With telehealth claim lines climbing by 2817% between December 2019 and December 2020, reliably authenticating patient identities in both existing and new services will be critical to future financial performance. Resolve, protect and enrich patient identities with universal identifiers Having the right technology to resolve and secure a patient’s information when they log on to patient portals and telehealth systems is the first step. Automating patient enrollment with Experian Health’s PreciseID® ensures the patient is who they say they are. This solution utilizes best practices in identity-proofing, fraud management and device recognition. But this system only works if the records being matched are accurate. A universal patient identifier provides a single, accurate, 360° view of each patient throughout their healthcare journey. An interoperable format allows systems to talk to each other and protects against duplicates, errors, inefficiencies and fraudulent activity. Universal identifiers aren’t available nationwide yet, though there has been some encouraging movement. Congress is working to remove the ban on funding for such measures, while the Centers for Medicare and Medicaid Services are taking steps to promote data standardization. For health systems that want to maintain a golden record for each patient within the bounds of their own operations, Experian Health’s Universal Patient Identifier allows staff to connect, verify and protect patient information. Choosing the right patient matching technology Traditional matching technology relies on demographic data and uses deterministic or probabilistic methods to link records with identical identification information. However, relying on a single source of data means that previous errors are inherited by new versions of a patient’s record. Demographic data isn’t unique to individual patients, which can lead to mismatched records and create extra manual work to fix. Experian Health uses referential matching technology to build a complete view of patients from reliable health, credit, and consumer data sources. The universal patient identifier connects disparate datasets and instantly updates the master index of patient records with new data points. Referential matching can only ever be as good as the data that is being matched and Experian is a global leader in data accuracy, across numerous sources, and is continually updated. Victoria Dames, VP of Product Management at Experian Health, says, "With Experian’s reference data, we’re able to create a longitudinal record of each individual and reconcile their data as they change names, addresses and see different providers. You need to know that it’s the same person, especially with the pandemic acting as a catalyst for digital technologies such as telehealth. It also helps organizations bring data together and ensure data integrity through mergers and acquisitions. Dealing with large volumes of data is a big hill to climb, but with the right technologies it can be that much faster.” As telehealth and digital patient access services gain traction, solving the patient identity problem becomes increasingly urgent. Universal Identity Manager combines industry-leading consumer demographic information with the highest quality reference data and powerful unique patient identifiers to create a single view of each patient. With better patient identity management, providers can protect against errors and fraud, and reassure patients that their personal information is safe. Find out more about Experian Health’s identity management solutions.

QR codes made an unexpected comeback during the pandemic. They offered a contactless gateway for individuals to check in to venues, log COVID-19 test results, help trace the virus spread and more. Restaurants and retailers embraced the technology as a way to welcome back consumers with touch-free access to online menus and digital payments. Previously seen as gimmicky and hindered by dependence on specific apps, these scannable squares can now be read using most smartphone cameras. With new use cases emerging during the pandemic, “quick response” codes are suddenly relevant again. However, the growing popularity of QR code technology opened the door to new cybersecurity risks, so providers must remain proactive with protecting patient identities. A 2020 survey found that almost half of consumers said they’d noticed an increase in QR codes since the first shelter-in-place orders. Online payment provider PayPal reported that a new merchant was added to its QR code payment option every 28 seconds in the first quarter of 2021.  Cybercriminals are capitalizing on consumer trust in QR codes to harvest personal data or install malware on devices. This leaves healthcare organizations and their patients vulnerable to fraud, especially given the increased adoption of digital healthcare technology during the pandemic. Providers must remain vigilant with protecting patient identities from QR code cybersecurity risks. How do QR codes threaten patient identities? QR codes hold far more data than traditional barcodes. They can be easily generated and fixed to any surface, ready for users to scan with their smartphones. They are primarily used to store URLs, which take the user directly to a website. But while savvy consumers are aware of the risks associated with clicking on a suspicious link in an email, QR codes are intrinsically trusted. It’s much harder to tell if a QR code is legitimate or not. Scanning a QR code is essentially the same as clicking on an unknown link. A study by MobileIron found that while 67% of consumers say they can identify a suspicious URL, less than 30% can identify a malicious QR code. Mike Bruemmer, VP of Experian Data Breach Resolution and Consumer Protection, says that "QR codes are the new stealth threat vector. Regardless of their application, no one can tell a fake code that launches malware on your device from a legitimate one." There are two main risks for patients. Firstly, they may click on a QR code that takes them to a web page that appears legitimate, prompting them to share personal data or log-in details. This information is then harvested by cybercriminals. This form of QR code phishing, known as “quishing,” puts the user at risk for spam, adware and identity theft. Secondly, the user may scan a QR code that takes them to a malicious site that installs malware on their device, which will then steal and package the user’s personal and financial data. The QR code can even be used to generate actions that appear to come from the user, such as making payments, sending emails, sharing locations or following social media accounts. In January 2022, the FBI issued a warning about cybercriminals using QR codes to redirect victims to malicious sites that steal login and financial information. Users are urged to practice caution when entering personal information after scanning a QR code. How can healthcare organizations help with protecting patient identities against QR code cybersecurity threats? For healthcare organizations, the concern is that if patients fall victim to a QR code scam, bad actors can steal personal identification data to access patient portals and other digital services. This information can be used to access medical services without paying, obtain medications illegally, or submit false health insurance claims, creating ongoing financial and administrative stress for patients. Or, if cybercriminals use captured information to log on as staff members there’s an added risk of further data breaches from inside the provider’s network. Healthcare organizations have a few options to help patients protect themselves from QR code scams: Targeted awareness-raising campaigns are a simple way to encourage patients to make sure their devices are updated with the latest security patches. Patients can be warned to watch out for suspicious activity, such as when a QR code redirects to a page that asks for personal details. They might also choose to ask for a direct URL, instead of using the QR code. Securing access to patient portals and verifying patient identities are practical measures to ensure that the person accessing the account is who they say they are. Another best practice in patient portal security is to take a multi-layered approach. This includes two-factor authentication, device recognition and additional checks on risky requests. By securing patient portals, providers can be proactive at protecting patient identities and reduce the risk of fraud during enrollment. Integrating patient identity management tools can also help verify the patient’s identity from the very first registration touchpoint all the way through their healthcare journey. Automated identity checks and algorithmic matching based on Experian Health’s unrivaled reference data can help ensure that the patient’s record is accurate and complete. Offering alternative secure methods for contactless patient payments and patient access are other options to make the patient experience more secure. For example, providing patients with their own mobile payment option means they can pay bills securely and access payment plans right from their phone. Experian Health also offers various safe and secure registration and scheduling solutions that will give patients a seamless patient access experience and help protect them from identity theft. Victoria Dames, VP of Product Management at Experian Health, says that patients have come to expect a smooth and secure digital experience: "Providers are focused on patient data security in adherence to multiple health policies, like HIPAA, but also to maintain confidence with patients. They [patients] are embracing digital solutions and expecting appropriate security measures are in place." Find out more about how Experian Health can help healthcare providers with protecting patient identities and close the door to QR code scammers. Experian Health can also help prevent other identity theft and fraud, verify that patients are who they say are, and provide safe, secure and convenient ways for patients to get the care they need.

“The patient can have a wonderful clinical experience but face a financial experience that falls short of expectations. We wanted a dedicated consultant who would recommend best practices and provide valuable industry insights. We wanted a system with proven results in back-end automation, operational improvement and analytical performance. We were looking to propel our patient experience to the next level and that’s why we partnered with Experian Health.” – Director of Patient Finance at Novant Health Delivering remarkable patient experiences is at the heart of Novant Health’s organizational vision. With a growing consumer base – the North Carolina health system logged over 5.8 million medical encounters in 2020 –  they turned to automated patient collections to ensure a better financial journey for their growing patient population. They also looked to automated workflows as a way to ease pressure on staff, who were managing 21 different collections agencies. The objective was to find a partner that could help to elevate agency performance while driving operational efficiency. With new facilities coming online, it was important to find a system that would integrate with Epic® and provide real-time reporting. Novant Health partnered with Experian Health to implement Collections Optimization Manager, which produces robust accounts receivable insights to determine each patient’s propensity to pay and scrub uncollectable accounts. The product also provides real-time reporting and agency scorecard, so providers like Novant Health can optimize their processes and forecast future performance. Predictive patient segmentation allows Novant Health to quickly identify the patients with the highest propensity to pay and prioritize accounts accordingly. Patients in need of financial assistance or charitable support can be directed to the right resources. Collections are faster, more efficient and more compassionate. With support from a designated Experian Health Collections Consultant, Novant Health can also monitor agency performance and keep agency costs in check. Improved patient segmentation, better allocation of staff resources and more efficient agency management has led to the following results: 8% increase in unit yield year-over-year 5% recovery rate a rolling average return on investment of 8.5:1. Discover how Collections Optimization Manager can help your organization improve collections recovery rates and deliver an improved patient financial experience.

In the decade since the Affordable Care Act sparked the transition toward value-based care and pay-for-performance care models, clinical services have been transformed by advances in diagnostics, medical devices and digital technology. However, despite a commitment to improving care quality and patient experiences, the healthcare industry still struggles to influence the factors that have the greatest impact on patient outcomes – the social determinants of health (SDOH). It’s now well-established that clinical factors have a relatively small impact on a person’s health-related quality of life. As little as 20% of the factors that influence health outcomes are attributable to clinical care. The remaining 80% includes social, economic and environmental factors – such as access to safe and clean housing, healthy food, education and transportation. Healthcare providers cannot be expected to solve these challenges alone. That said, providers will benefit from developing plans and investing in systems that foster awareness of the social determinants of health that impact their communities. This will help enable the delivery of the proactive and coordinated services patients need to live healthier lives. The pandemic intensified many of the socio-economic barriers patients face when accessing care, medication, housing and food. It forced sudden changes to the way care was delivered, making it harder for healthcare organizations to sustain high-quality services. When overwhelmed hospitals just needed to get through the day, value-based care took a hit. To support underserved communities, healthcare organizations need reliable insights into their patients’ evolving life circumstances and socio-economic challenges. SDOH data can help providers identify the right strategies to serve their patient population in the most effective way. SDOH should be at the heart of patient-centric services. Healthcare organizations that prioritize the use of SDOH data are strengthening their ability to deliver value-based care. How has the pandemic affected SDOH and value-based care? Value-based care and pay-for-performance models were gaining traction just before the pandemic, and many providers were agile enough to respond quickly to the pandemic with telehealth and other remote services. But against a tsunami of COVID-19 cases, tests and vaccination programs, reimbursement models based on quality measures such as effectiveness, efficiency and timeliness proved fragile in the midst of an emergency. As is often the case, the worst effects of the pandemic were felt most acutely by marginalized and economically vulnerable groups. For example, groups with less stable employment were less likely to have access to sick leave or remote working opportunities, putting them at greater risk of catching the virus. Many community programs were put on hold, with consequences for the individuals who relied on them for food, support, and company. Insights on the social determinants of health can help providers segment vulnerable populations that need extra assistance to take control of their health. Once these populations are identified at the patient level with insights driving one’s unique SDOH risks, providers can develop strategies to ensure the right help is given at the right time. They can offer targeted outreach to ensure patients are able to adhere to care plans and access health checks, even take their medication as prescribed. This can reduce the risk of readmission, minimize hospitalizations, and keep healthcare costs down for both patients and providers. To supplement reliance on expensive and time-consuming patient surveys (that often leave out the “why” of a patient’s circumstances), Experian Health’s SDOH solutions combine analytical expertise, machine learning and proprietary data to generate actionable recommendations on the best way to address barriers to care, medication, housing and food. Combine SDOH and consumer data to personalize patient outreach The key to successful value-based and pay-for-performance care models is treating the patient, not just the disease. Data on SDOH allows providers to offer a more personalized healthcare experience, which is even more powerful when combined with consumer data. ConsumerView pools data on patient interests, psychographics, behavioral insights and broader lifestyle insights to give providers a 360-degree view of their patients. With this data, providers can offer relevant and timely advice to help patients overcome potential obstacles to attending appointments and complying with their care plan, such as information about transportation or childcare. It can be used to personalize healthcare communications too. Rather than blasting patients with one-size-fits-all healthcare information, communications can be tailored to patients’ preferred time and format, so they’re most likely to engage with the message. Making value-based care a reality starts with knowing who your patients are and what’s stopping them from getting the care they need. Find out how Experian Health’s Social Determinants of Health turn-key solutions can give your organization the insights needed to develop resilient and responsive models of care. With these tools, your organization can lay the groundwork to improve patient outcomes, regardless of the challenges that lie ahead.