No healthcare organization is immune to the problem of bad data. One in five patients has found errors when looking at their electronic health record (EHR). This includes incorrect information about their diagnosis, medications, test results and more. If the data held in patient records is incomplete, inconsistent, or inaccurate, this can lead to poor clinical decision-making, substandard patient experiences, and gaps in treatment or follow-up. In Experian Health’s State of Patient Access 2.0 survey, patient identity management emerged as a major challenge for healthcare providers, with almost half of the respondents saying that inaccurate and incomplete patient data hindered follow-up contacts and patient outreach. “Dirty” data also presents a major financial risk, costing healthcare organizations millions of dollars per year. Many providers have stepped up their digital offerings in the last few years, particularly in response to the pandemic. While digitalization offers huge advantages, it does have an unfortunate side effect. As more data is created, shared and accessed, there are more opportunities for mistakes. Some industries may accept a certain amount of rogue data as inevitable, but in healthcare, it mustn’t become the norm. Patient data needs to be consistent, complete and standardized to ensure the highest standards of care. The Centers for Medicare and Medicaid Services (CMS) recognizes the need for an easier and more secure exchange of healthcare data, and are taking steps to facilitate interoperability. As these provisions are finalized, providers can act now to embed data standardization in their digital services. Better data means better decisions, better care and lower costs. As the digital transformation continues, providers must implement strategies to eliminate inaccuracies, enable consistent identity management, and ensure data is standardized across all their systems and networks. In this article, we share three steps to help your organization ensure that patient data remains complete and consistent for better patient identity management. 1. Start with the right patient data As the saying goes: garbage in, garbage out. Reliable patient records require the right information to be added from the start, or errors will follow the patient throughout their healthcare journey. This will only continue compounding over time. A 2021 survey of Experian Health clients revealed that incomplete data arises for a variety of reasons. This ranges from patients not filling out forms correctly prior to their visit or forgetting their insurance cards, to staff having limited time to complete documentation. Typos, misspellings, duplicate data and missing information can also cause identity errors.* Providers should reduce the risk of inaccurate data from being added to a patient’s record in the first place. A standardized approach to data formatting is a good place to start. For example, if a patient is accustomed to writing their date of birth in a European format, with the day before the month, they may enter this incorrectly when filling out online patient access forms. Configuring calendar drop-down menus in such a way that prevents this will avoid these basic but costly errors. With a Universal Identity Manager (UIM), each patient’s record can be maintained in a standardized format. Probabilistic and referential matching techniques are used to check the patient’s identification information against existing databases, for a more complete view of the patient regardless of any data gaps. 2. Solve patient matching challenges with robust identity verification It doesn’t matter if patient records are accurate if staff pull up the wrong record when they speak to a patient. Providers should prioritize consistent identity management to ensure clinical and non-clinical staff see the same and correct information, regardless of where or when a patient interacts with their organization. Identity Verification validates the patient’s identification information during pre-registration and check-in by instantly accessing demographic information. This includes the patient’s name, address, Social Security number, date of birth, phone number and insurance coverage data. If there’s a mistake, it’s easily found and corrected. 3. Standardize data to maintain clean patient databases Victoria Dames, Vice President Identity Management at Experian Health explains why standardization is so important: “The increasing use of digital services means that more healthcare data is being exchanged within and between health systems than ever before. However, in order to leverage the opportunities that come with a more connected healthcare system, we need that data to be as reliable as possible. Preventing inaccuracies before they occur will be much more cost-effective than scrambling to fix them after the damage is done. With a standardized approach to data collection and management, healthcare organizations can maintain reliable records for every individual patient and stay ahead of the game as more data is generated and shared.” Unique Patient Identifier (UPI) helps providers eliminate duplicate records so there’s a “single source of truth” for each patient. After the UIM matches the patient’s information within a single and accurate patient file, a UPI is assigned to that record and maintained in a master index. This is far more secure than a traditional matching algorithm based on Social Security numbers, which can be vulnerable to errors. Together, these tools help healthcare providers create and maintain a “golden record” for each patient. Data quality will always be a challenge. However, with the right data standardization strategies, providers can make better decisions. This will create better patient experiences and better health outcomes while limiting the financial impact of dirty data. Contact Experian Health today to find opportunities to clean up your healthcare data for better patient identity management. *Survey of Experian Health clients, October 2021 Are you an Experian Health client? Then we invite you to join our Innovation Studio research community. Your ongoing input is key to driving improvements to our tools and products! Sign up here!

US hospitals have provided more than $702 billion in uncompensated care over the last two decades. To protect profits, healthcare organizations must be vigilant about finding any available insurance coverage for their patient’s care. But for many, recent regulatory changes and pandemic-related disruption have made navigating an already complex reimbursement landscape even more challenging. Checking for missing insurance coverage and chasing payments consumes staff time that could be better spent elsewhere. However, with the right revenue cycle management tools, healthcare organizations can reduce profit-eating write-offs and denied claims. Experian Health’s new white paper sets out an end-to-end strategy to help healthcare providers find missing and forgotten coverage. With a comprehensive game plan for minimizing lost revenue at every touchpoint in the patient journey, providers can optimize the patient experience, reduce revenue leaks, and ease the burden on staff. Here, we explore some of the trends that are challenging reimbursements, identify opportunities to find missing coverage quickly, and present best practices to eliminate the risk of bad debt at every stage of the patient journey. Trends that make revenue recovery tougher Healthcare providers must keep abreast of regulatory changes that affect the reimbursement process, which often challenges profitability. For example, the American Rescue Plan Act of 2021 made some key changes to the Affordable Care Act. This included expanding Medicaid provision, decreasing Medicare premiums, and accelerating the COVID-19 vaccination program. For providers, this means an influx of patients who are newly entitled to government assistance, requiring new processes to avoid delayed claims and payments and recover Medicare debt. Many of these measures are a response to the pandemic. COVID-19 has squeezed household finances, leaving some patients without jobs and access to health insurance. Although employment rates are showing signs of recovery, tracking coverage as patients start new jobs remains highly resource-intensive for collections teams. Chasing self-pay revenue can often be more expensive than writing off the initial bill. The growing focus on price transparency may mitigate some of these challenges. Proactive patient engagement can help patients understand and plan for their bills while improving the overall patient experience. The No Surprises Act, effective January 1, 2022, aims to protect patients from unexpected bills for out-of-network care in emergency and non-emergency settings. The regulation protects patients but creates significant work for providers to modify existing processes and systems in order to meet compliance standards. Dustin Whittier, Senior Director of Product Management at Experian Health, explains that automating early coverage checks can be an efficient way to help consumers manage their changing healthcare obligations. He says, “With the increase in high deductible plans, the urgency surrounding COVID-19, regulations such as the No Surprise Act and Notice of Care, and a strategic focus on patient satisfaction and transparency, the impetus to automate knowing the full scope of insurance coverage – as  close to the point of care as possible – has never been greater.” In 2021, Coverage Discovery tracked down previously unknown billable insurance coverage in more than 27.5% of self-pay accounts. The Experian Health team can help healthcare organizations keep on top of changing regulatory requirements and implement solutions that ensure compliance, improve the patient experience, and protect against uncompensated care. Optimizing for revenue recovery at every step of the patient journey Successful revenue recovery starts with a patient engagement strategy that simplifies the steps to reimbursement at every patient touchpoint. A three-pronged approach can increase the likelihood of payment by identifying the opportunities to check for coverage before the patient comes in for care, at the time of service, as well as aftercare. 1. Pre-service insurance coverage checks Verifying and tracking the patient’s insurance status before they come in for care means their financial obligations will be clear from the start. Advance knowledge makes it much easier for patients to plan – and pay ­– their medical bills. An automated coverage identification solution such as Coverage Discovery can scan patient information as soon as they schedule an appointment to find any previously unknown coverage, using multiple proprietary databases and historical information. 2. Identifying coverage at the point of care When the patient receives their treatment, Coverage Discovery can check for any billable commercial and government coverage that may have been missed during pre-service. Providers should also give patients opportunities to pay for care at this point too, to avoid the need to chase for payments later. A simple and quick payment experience can reduce the risk of additional A/R days and collections agency fees. 3. Post-service checks for unidentified coverage Finally, for any accounts that haven’t been settled at the point of care, providers should run further coverage checks before determining whether to send statements and payment reminders to the patient, to write the amount off as bad debt, or to engage a collections agency. Coverage Discovery can detect any discrepancies that could lead to denied claims. It also offers weighted confidence scores so that accounts are reclassified and rebilled appropriately. Automated scrubbing can eliminate manual processes so staff can use their time more efficiently. These steps will help plug revenue leaks at every stage of the patient journey. Not only will that improve cash flow and reduce the risk of bad debt, but it also helps create a more satisfying patient experience. Learn more about how Coverage Discovery helps recover revenue throughout the patient journey and gives patients peace of mind.

According to a recent survey by PYMNTS, many patients want digital healthcare management tools. 76% of survey respondents said they were “very” or “extremely” interested in using at least one digital method to manage interactions with their healthcare providers, rising to 86% among younger patients. This finding echoes Experian Health’s research from our State of Patient Access 2.0 survey. In this survey, we found that the pandemic had cemented consumer expectations around convenient access to care. Providers that wait too long to open their digital front door risk losing consumers to competitors. The “digital front door” describes how a patient can find and access care through online and digital channels. This can include everything from booking appointments and virtual waiting rooms to contactless payments and telehealth. It’s more than just patient access: digital technology can create convenient and connected patient experiences throughout the entire patient journey. The goal is a patient experience that flows seamlessly between in-person interactions and virtual touchpoints, from finding care to post-visit follow-up. Experian Health’s clients revealed that many have embraced digital tools to deliver a patient experience that matches consumer expectations, driven in large part by the pandemic.* Some are planning to invest in their digital front door within the next year, while resource constraints are hampering others in moving forward. Healthcare providers in the early stages of digital transformation may be wondering where to start. Where should they focus limited resources for the biggest gains? The four opportunities that could offer the greatest return on investment are online scheduling, omnichannel communications, contactless payments and productivity-boosting automation. Help patients find and book appointments with easy online scheduling Last year’s State of Patient Access 2.0 survey found that nearly eight in ten consumers prefer to schedule their own appointments at any time, from any device. This trend is set to continue in 2022 and beyond. Many patients have been using online scheduling platforms to book COVID-19 vaccinations and tests, as well as to reschedule care that was delayed during the earlier months of the pandemic. Opening the digital front door with online scheduling offers patients the control, convenience and choice they desire. No-shows are less likely, which leads to higher physician productivity and satisfaction, greater efficiency, lower costs and better patient outcomes in the longer term. Communicate through patients’ preferred channels to boost engagement With the pandemic necessitating so many rules around daily activities, limits on how and when consumers communicate with their providers can feel even more restrictive. Many don’t want to be forced into phone calls at inconvenient times, especially when a simple text reminder or a quick check of their patient portal would do the job. Providers that allow consumers to customize their patient access experience and engage through their preferred channels will be rewarded with increased patient loyalty. Omnichannel solutions also help to build a consistent care experience. A digital process that looks and feels the same every time, regardless of which platform the patient uses, will make navigating the care process much easier. Additionally, patients will be more likely to schedule appointments and fill out forms in a timely manner on their own, which can alleviate staffing resource constraints. A digital front door can help with contactless payments One part of the healthcare experience that can be notoriously tricky to navigate is paying for care. PYMNTS found that 63% of patients would consider switching healthcare providers over a bad payment experience. Providers can make it easier for patients to pay by offering upfront estimates of what the patient’s portion of the bill is likely to be, running automated coverage checks to make sure no insurance is missed, and sending automated reminders with links to contactless payment methods. According to PYMNTS, less than 20% of patients pay for care before or during their visit. However, if providers made it easier to pay, this percentage would likely shoot up. By offering patients their own mobile financial advisor, they can pay bills and access appropriate payment plans right from their phones. It’s convenient for patients and could help reduce delayed payments. A digital front door can improve patient access and relieve pressure on staff A digital front door doesn’t just open up opportunities for patients; it can increase efficiency and improve staff workflows. Healthcare staffing shortages have put immense pressure on providers to find new ways to automate repetitive tasks and relieve staff burnout while maintaining high-quality patient care. For example, automated scheduling algorithms can optimize patient flow and anticipate bottlenecks, so staff can allocate resources more efficiently. Registration forms that are pre-filled with a patient’s information are less prone to errors, compared to manual processes. Automation helps link the digital front door to the front and back offices, which can speed up workflows, support better care coordination, and create a more consistent patient experience. A high-quality digital patient experience should be built on consumer choice, control and convenience. A digital front door is more than just adding a few online tools or sending some well-timed automated texts; it should be at the heart of the entire patient engagement strategy. By investing in digital solutions that leverage the technology already used by patients and staff, providers can offer a stand-out patient experience and improve collections performance. Contact Experian Health today to find out how digital health solutions can help your organization deliver the best patient experience possible. *Survey of Experian Health clients, October 2021 Are you an Experian Health client? Then we invite you to join our Innovation Studio research community. Your ongoing input is key to driving improvements to our tools and products! Sign up here!

The COVID-19 pandemic has highlighted the need for a more responsive, flexible and resilient approach to revenue cycle management, underscored by provider staffing shortages across the country. Automation is gaining momentum as a way to address the staffing issue while improving efficiency and collections optimization to levels better than those prior to the pandemic. Furthermore, with the No Surprises Act effective as of January 1. 2022, automation and digital tools can help providers deliver transparent pricing with real-time cost estimates. With automated healthcare collections, providers can help patients plan for their healthcare costs. This is especially important, given that half of Americans currently have unpaid medical bills. In North Carolina, Novant Health is already seeing an impressive return on their investment in automated patient collections technology. The provider logged over 5.8 million medical encounters in 2020. Novant Health’s patient finance team wanted to address growth while continuing to deliver an improved patient financial experience. They wanted to automate workflows and processes to reduce the need for staff intervention, using a wide-ranging platform that would easily integrate with Epic and provide robust reporting and insights. Compiling agency performance reports for 21 agencies each month was another cumbersome task, so the team also wanted a partner who would help elevate and monitor agency performance. Watch our webinar with Novant Health to see how they used Collections Optimization Manager to increase patient collections and create better patient financial experiences. Delivering a “human experience” with the right patient collections partner Wendi Bennett, Director of Patient Finance at Novant Health, said it was important for them to find a strategic and collaborative partner who would understand their commitment to providing a remarkable patient experience: “The patient can have a wonderful clinical experience but face a financial experience that falls short of expectations," said Bennett. "We wanted a dedicated consultant who would recommend best practices and provide valuable industry insights, and 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.” Automated healthcare collections insights for a better patient experience and fewer unpaid medical bills Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, is the Collections Consultant who has been working with Wendi’s team to implement the Collections Optimization Manager. Cari explains how the Collections Optimization bundle delivers the data insights and execution support that Wendi and her team were looking for: “We’re able to extract data from the facility’s accounts receivable file and produce robust analytics and insights. That allows us to screen or scrub out those accounts that we should not be scoring or segmenting. Then, we shift to the customized segmentation which provides the client the ability to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.  Customized segmentation also gives the client the ability to keep the best, most collectible accounts in-house longer and give the lower yield accounts to their early out agency sooner. We drive revenue back in the door by focusing on these accounts. Finally, we monitor for new insights into patients’ propensity to pay. And with Collections Optimization Manager, our clients receive consultant support as part of the bundle, who provide best practices, insights and analysis throughout the relationship.” Highly predictive patient segmentation means that Novant Health knows which patients are most able to pay, those eligible for charitable support, and who should be directed to different payment plans. This supports more compassionate financial conversations and communications with patients. It also creates opportunities for personalized recommendations, such as reminding new parents to ensure their child is included on their healthcare insurance. The more transparency, simplicity and compassion that can be built-in, the easier the process will be for patients. For providers like Novant Health, that means fewer bills being written off. Efficient allocation of patient collections staff resources Collections Optimization Manager also allows providers like Novant Health to focus their efforts on the right accounts. It doesn’t make sense for staff to spend valuable time following up with patients who have a low co-pay amount and a high likelihood to pay. Simple automated reminders address that situation. The Novant Health team used automated dialer campaigns to reduce manual outbound calls and allocated limited staff resources to more complex accounts. A split-screen shows staff all the information they need during the call, eliminating the need to log into multiple systems at once. Call recordings stop automatically before the patient shares their credit card information, ensuring PCI compliance without extra steps. Keeping track of collections agency performance – and costs With Collections Optimization Manager, Novant Health can prioritize high propensity-to-pay accounts in-house, which helps to manage agency costs. A customized scorecard and dashboard keep track of agency benchmarks, giving the executive leadership team a real-time snapshot of performance, informing decisions about vendor management. The Compliance Manager function helps Novant Health ensure agency collections have compliance at top of mind and are not solely focused on the highest yield accounts. This function, combined with better segmentation and a higher call connection rate, results in higher recovery rates. With Collections Optimization Manager, Novant Health has seen a 5.8% increase in unit yield year-over-year, and an overall recovery rate of 6.5%. Overall increased revenue and cost savings amount to an impressive rolling average return on investment – 8.5:1. Watch the webinar to find out more about how Novant Health boosted its patient collections recovery rates with an automated healthcare collections platform. Find out more about how Collections Optimization Manager can help your organization use automation and digital tools to create a more efficient patient collections process and a more streamlined patient financial experience.

Claims denials are a major source of headaches for healthcare organizations. On average, denied claims can take more than two weeks longer to pay out than first-time claims, if they get paid at all. Denials can have major downstream impacts, including lower annual net revenue, additional hours spent on administrative work, and potential disruptions to patient care. Claims denials aren’t just an occasional inconvenience, either. A recent American Hospital Association (AHA) survey found that 89% of all hospitals and health systems have seen a rise in denials over the past three years, with half of the participants describing the increase as “significant.” Data from Healthcare.gov confirms this trend. The Kaiser Family Foundation (KFF) states that in 2019, health plans available on the individual market denied an average of 17% of all claims – up from 14% the year before. It’s becoming more critical than ever for healthcare organizations to employ integrated, intuitive, and technology-driven strategies to get their claims paid in a timely and efficient manner. Reduce claim denials by eliminating administrative errors and manual processes Health plans can deny claims for any number of reasons. The good news is that in 2019, KFF found that less than 1% of claims were denied based on medical necessity. The bad news is that the remaining 99% were denied largely due to other reasons. This included referrals, prior authorizations, coverage disputes, data errors, and clearinghouse problems. Many claims denial issues occur when organizations rely on manual processing of complex documents that are subject to ever-changing requirements from a wide variety of payers. Mistakes are not uncommon, and that ends up costing time and money. Smart, intuitive claims management workflows that take advantage of automation technology can augment staff resources and reduce the likelihood of errors. Automation contributes to clean and accurate claims the first time around. According to the Council for Affordable Quality Healthcare (CAQH), manual processing can take an average of four minutes per claim. Automation cuts this time by 25%, bringing the total time per claim down to just three minutes. This might not seem like a lot in isolation; however, it becomes more material when the time savings is applied to a large, multi-hospital health system that partnered with Experian Health to revamp its claims processes. The health system gets through 200,000 claims per month. That could translate into 200,000 minutes saved – or more than 3,300 hours – every 30 days. Amidst the staffing shortages that are persistent in healthcare, those numbers are significant. For providers of all sizes, the right automation tools use an expansive library of national payer edits, supplemented by custom edits, to ensure that claims are clean before they get out the door. These tools can also organize and prioritize accounts to help staff members use their time most efficiently. If a claim does have an issue, organizations can use additional technologies to stay one step ahead of the denials process. Enhanced claim status monitoring can give providers insight into potential problems long before the ERA and Explanation of Benefits are processed. This allows organizations to address known issues and predict their revenue cycle outcomes earlier and more accurately. Automation can also help providers slash even more time off the claims management process. The Council for Affordable Quality Healthcare (CAQH) estimates that it takes between 14 and 30 minutes to complete a manual claims status inquiry. Automated status monitoring can potentially shave 9 minutes off this task, freeing up staff to complete other tasks. There’s still plenty of options when claims do get denied. Providers can complement their claims capabilities with denials workflow management tools that can generate customized worklists, highlight ANSI reason codes and payer proprietary codes, and identify payer-specific denial trends to help inform decision-making. Automation creates a faster, more accurate claims processing ecosystem Most healthcare organizations use a number of different technologies to manage their revenue cycles, and all these systems must work together in harmony. Unfortunately, interoperability across disparate clinical and financial systems isn’t easy to achieve. In the case of the provider that chose Experian Health to improve its claims process, integration with Epic, its medical records system of choice, was very important. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, and found and repaired issues with the system build, creating opportunities for cross-training and centralized reporting. Thanks to this automated, integrated process, this provider improved its acceptance rate by 10 percent, consistently seeing 99 percent of its claims accepted. Additionally, its clean, paid claims percentage increased by over 10 percent, creating a more predictable, profitable revenue cycle. With denials on the rise in an increasingly challenging claims management environment, providers will benefit from replacing manual processes wherever possible.  Automation is the key to optimizing staff resources and significantly reducing reimbursement obstacles. To see sustained success with your revenue cycle, get in touch with Experian Health and start automating your claims process today.

As patient expectations shift, providers that offer a personalized healthcare marketing experience will be more likely to attract and retain satisfied consumers. The pandemic accelerated this shift. As a result, the traditional ways of healthcare marketing are starting to fall short. For example: A healthcare marketing strategy that’s designed for an “average consumer” results in a one-size-fits-all model that doesn’t always meet a patient’s individual needs. Communication options with fixed hours and channels don’t reflect “patient first.” Outreach messages blasted to an entire patient email list miss the mark for individuals who don’t speak the language or might prefer a quick text message instead. A study by Dassault Systèmes and CITE Research found that 83% of consumers expect products and services to be personalized within moments or hours. They’re accustomed to the “one-click” digital retail experience, which offers instant access to relevant recommendations and flexibility about how and when to buy. They’re also suffering from information overload, thanks to the sheer volume of emails, messages, articles and videos flooding their digital devices. Personalized communications can remedy that and help consumers feel respected and empowered, which drives connection and loyalty. But personalization isn’t just important for patient outreach. Personalized healthcare marketing can also help ensure patients get the treatment they need, by anticipating individual needs and highlighting relevant services at the right time. With the COVID-19 pandemic continuing to influence access to care, personalized healthcare communications can also be tailored for different patient segments. This can help reassure or remind individuals to book vaccination appointments or reschedule deferred care. Improve patient engagement with personalized outreach As digital offerings grow, consumer engagement expectations evolve. Providers must keep pace and communicate accordingly. Incorporating information about patients’ lifestyles, behaviors and preferences enables providers to deliver the right message at the right time. It also helps providers select and use the most effective channel of communication. Patients are more likely to respond and are empowered to manage their healthcare journey. For example, a Gen Z patient may prefer to receive appointment reminders by text, while an older patient may prefer a physical letter. One patient may prefer to get prescriptions mailed to their home while they’re at work, while another may be content to visit a pharmacy and pick up their medication while shopping nearby. Some patients will want a text message with a payment link to clear outstanding bills immediately, while others will appreciate a customized payment plan. Experian Health’s State of Patient Access survey 2.0 found that patients welcome proactive outreach by providers, though many say this doesn’t happen. Providers recognize the value in proactive patient engagement, but many say they lack the data to reach out effectively. With reliable consumer data and analytics, providers can create holistic profiles and deliver improved marketing to better serve new and existing patients. ConsumerViewSM pools data points on core demographics, behavioral insights, psychographic information and financial data to help providers understand their patients. This data can then be analyzed using Mosaic® USA and TrueTouchSM to segment, identify and reach the target audience with the most relevant message and format, and adapt based on consumer response. ConsumerView also adheres to consumer data privacy regulations, so providers can actively engage patients and build patient loyalty while confident in the knowledge that they have permission to use the data. Reduce readmissions and improve patient outcomes with better segmentation Personalized healthcare marketing isn’t just about messaging and channels. Providers that have a holistic picture of a patient’s lifestyle, life events, geographic changes and socio-economic challenges will be in a stronger position to anticipate their evolving wants and needs. For example, social determinants of health (SDOH) data can tell providers which patients may need extra assistance when visiting a doctor’s office, so that appropriate measures can be put in place. They might help identify patients with potential comorbidities that warrant proactive reminders about preventive check-ups. Similarly, providers can segment patients according to their financial situation. This can help with creating custom payment plans and sending timely payment reminders through targeted communications channels. Effective post-admission engagement can also help patients access the support needed to adhere to care plans, thus minimizing the risk of readmission and reducing unnecessary costs. A McKinsey & Co study found that around a third of patients with unplanned, high-cost follow-up care reported reasons that were considered avoidable, such as receiving unclear post-discharge instructions. Boost retention and recruitment with patient-centric and personalized healthcare marketing As rising medical costs and pandemic-related lifestyle shifts prompt more patients to shop around for care, providers must take action to create a healthcare experience that’s truly patient-centric. With data-driven healthcare marketing tools, providers can differentiate their services from other health systems vying for the same market. Find out how Experian Health can help your organization use consumer insights to build a patient-focused, personalized health marketing strategy to attract and retain satisfied consumers.

Experian Health works with many of the largest, most sophisticated collections teams in healthcare that consistently strive for high-performance by innovating and adopting best practices. Our consultants are often asked to define “high-performance”. What separates high-performing collections teams from the rest and how do they impact the bottom line? Being a leader in data and analytics, we used our expertise to conduct an in-depth analysis to answer these questions, quantify the impact of high-performance, and identify best practices common to high-performing collections teams. Here is what we learned: 1. Spend time collecting on the right accounts Many health systems have developed collections workflows by segmenting self-pay accounts into varying buckets depending on the propensity to pay. However, not all segmentation models are created equal and ultimately a model is only as good as the data driving the decisions. Segmentation models are supposed to identify high and low propensity-to-pay accounts so that resources can be focused on collecting from accounts likely to yield revenue, building out custom workflows when possible. In fact, in a head-to-head comparison, a health system using a segmentation model based solely on patient payment history significantly underperformed a health system using a comprehensive, multifaceted segmentation model built using our Collections Optimization Manager. Here are the results: $60,000 in additional revenue generated from accounts in low payment likelihood segments 25% higher recovery rate in highest payment likelihood segments 100 more accounts worked in low payment likelihood segments Multi-faceted segmentation models increase recovery rate an average of 76% for the highest payment likelihood segments Using patient payment history within a single health system forces a decision to be made based on limited information. This leads to more time being spent on accounts that yield little to no revenue. Patient financial situations change rapidly and being able to see additional factors such as credit payment history, household income, and financial stress signals improves the ability to assess propensity-to-pay. This is particularly important for both new patients and those that visit infrequently. Utilizing a comprehensive segmentation model enables collections from the accounts and increases recovery rates for segments with a high propensity-to-pay. 2. Use automated dialing Imagine a world in which every collections call reaches the intended recipient. When comprehensive segmentation models are used in tandem with automated dialing technology, like Experian Health’s PatientDial product, the hypothetical can turn into reality. High-performing teams take output from their comprehensive segmentation models and use it to focus call center activity. The logic is simple; more contact attempts are made to reach accounts likely to pay and fewer attempts are made for low yield segments. For example, if a health system with 100,000 new monthly accounts uses a data-driven call strategy, call volume can be reduced by up to 20,000 calls per month. The highest-performing teams go a step further by pre-loading call lists into agent software and only allowing agents to join calls that successfully connect. This is where the real magic happens – valuable time is saved, and agents actually connect with more patients, ultimately increasing collections success. 3. Monitor agency performance It is no secret that some agencies perform better than others. In fact, even a trusted agency’s performance can vary over time as portfolios are rotated between different collection teams. So, what do high-performing collections teams do to influence consistent agency results? They use robust reporting to monitor and track agency performance over time. This helps direct account allocation decisions in a way that impacts the bottom line. It is Monitoring agency performance gives revenue cycle leaders the information needed to make better portfolio allocation decisions. Another benefit of monitoring agency performance is that agencies perform better just knowing they are being monitored, per an Experian Health analysis of agency performance across similar portfolios. Here are the key metrics: Monitoring agency performance enables better account allocation decisions, pushes agency partners to perform at a higher level, and significantly increases collections. 4. Reduce bad debt through presumptive charity Best-in-class providers automate the financial assistance process for low-income self-pay individuals. This has a significant impact on both patient and provider. Patients no longer receive statements or calls for an outstanding debt that they are unable to pay, and providers are able to save on variable expenses, such as statement and call costs, in addition to staff time spent manually inputting and verifying financial assistance applications. Automating the charity award process enables health systems to reduce bad debt expense, regardless of when awards are granted. In a comparison between health systems using an automated financial assistance process and a similar portfolio of health systems without automated financial assistance, we discovered that automation could reduce bad debt expense by as much as 10-12% on a similar demographic mix of consumers. [1] 5. Identify accounts that require special handling One of the most common mistakes that collections teams make is dedicating time and resources to accounts that are unlikely to yield revenue. Deceased or bankrupt accounts make up anywhere between 1 percent to 2 percent of self-pay portfolios. This means that for a monthly portfolio of 100,000 accounts, collections teams are unnecessarily calling or mailing statements for up to 2,000 accounts that require special handling and might produce no results at all. High-performing collections teams have automated processes in place to identify these accounts and either remove them from the AR file completely or place them with a specialty vendor as soon as possible. High-performing teams also focus on identifying and resolving incorrect patient addresses. Although mailing patient statements is a key part of nearly every collections workflow, undeliverable mail often remains unworked. Since accounts are less likely to yield revenue over time, it is imperative to identify and resolve address discrepancies quickly. Returned mail typically impacts 1 percent to 4 percent of a self-pay portfolio. This means in a situation with 100,000 new accounts each month, an additional $30,000 can be recovered using an automated process to identify and update undeliverable addresses. Interested in learning more? For more information on our healthcare collections products, click here.    [1] Data Study Methodology: In June of 2021, Experian Health performed an analysis on a nationwide sample of health systems to define industry best practices and quantify their impact.

The No Surprises Act, effective Jan. 1, 2022, requires that healthcare providers include a “Good Faith Estimate” that covers all relevant codes and charges. This was established to increase price transparency for patients. For a summary of the No Surprises Act, read our previous blog. In our recent webinar, hosted on December 15, 2021, industry expert Stanley Nachimson, principal of Nachimson Advisors*, answered our audience’s most pressing questions about “Good Faith Estimates.”** To read the FAQs from our first webinar, click here. Experian Health can help your healthcare organization navigate the regulatory landscape  and implement solutions ranging from transparent, patient-friendly estimates to our all-new FREE No Surprises Act (NSA) Payer Alerts Portal.  Here’s what Nachimson had to say: Q1: What are the top things to do now to prepare for the No Surprises Act by Jan. 1? SN: Set up processes to avoid out-of-network billing for emergency and in-network facility services Out-of-network providers need to make sure they have the right processes set up to avoid surprise billing patients. Evaluate in-and-out of network status for all providers Implement Good Faith Estimate for Uninsured/Self Pay from a single provider Make sure to have a process in place for self-pay or uninsured patients Prepare patient notice documents Train staff and ensure they’re aware of new rules and changes Q2: What must be included in the Good Faith Estimate starting 1/1/22? SN: Starting Jan 1, 2022, the only Good Faith Estimates required are for “self-pay” or uninsured patients. These are the only ones that will be enforced/mandated on January 1st. CMS has created forms that show what GFEs should include. This includes individual services that will be provided in an encounter, line-item descriptions of services, procedure codes, diagnosis codes, and more. Estimates should be within $400 of the final bill for any provider or facility that was included, assuming there are no extenuating circumstances. Q3: How should providers deliver the Good Faith Estimate to the patient? Payers? SN: For patients, Good Faith Estimates should be delivered in a written document. This can be done through email, USPS, or delivered in person. Currently, providers do not need to worry about sending anything to payers. Regulators put this requirement on indefinite hold until they have more clarity on the technical delivery/transition of this data. CMS expects to provide a ruling clarification on this in 2022. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. Q4: What are the differences between Insured & Self-Pay Good Faith Estimates that providers should consider starting Jan. 1? SN: There will probably be no significant difference in the GFEs for self-pay vs insured individuals. However, the GFEs will be sent to health plans for the insured individuals. At this point, there is no standard electronic delivery method. Individual providers/organizations may come up with their own paper or electronic form, assuming it contains all the required information. At some point in the future, the GFEs will be sent to health plans for insured patients, and that will most likely be a standard transaction. CMS is currently waiting on guidelines for what this transaction will look like. Q5: How does an estimate get calculated when there are multiple providers involved? Who is the “convening provider?” SN: A convening provider is the provider that (1) is responsible for scheduling the primary item or service(defined as “the initial reason for the visit”), or (2) receives a request from an individual shopping for an item or service)—must determine at the time an item or service is scheduled or when a patient is shopping for care whether the patient is a self-pay patient, as defined above. This will not be enforced on Jan. 1, 2022. In 2022, each provider will be expected to provide the GFE for their own services. Because there aren’t any processes in place, the healthcare industry will have at least 1 year to develop a standard guideline for gathering this information. The requirement that the convening provider combines all provider GFEs into one GFE will not be enforced until 2023.This means that over the course of 2022, the convening provider will not be required to include estimates from other providers.  The industry will need to create a standard guideline and establish communication processes first. Until then, patients will need to ask every provider involved for a Good Faith Estimate.  Providers may wish to consider how they will accomplish this during 2022. Q6: Does the Good Faith Estimate apply to all services – even office visits? Labs? Urgent care? Drop-ins? SN: It applies to all types of services. However, depending on when the service is scheduled, the timeframe will vary on when the Good Faith Estimate can be sent out. Q7: If the actual charges are more than $400 greater than the Good Faith Estimate, what consequences will be there for providers starting Jan. 1? SN: The latest rule established an independent dispute resolution process.  The patient must initiate the process within 120 days of receiving the bill, file the required documentation and pay a $25 administrative fee. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of December 23, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey – including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.  

The recent discovery of the Omicron variant has placed the world on high alert. As COVID-19 continues to transform and evolve, erupting as “new” pandemics within the existing pandemic,  it is becoming clear that digitally-enabled clinical care and access to that care are some of the world’s tools to mitigate its spread. Should infection rates rise, providers can anticipate fluctuations in patient volumes, which may trigger a return to the scheduling complexities seen earlier in the pandemic. Streamlining patient access with digital scheduling to minimize wait times, free up hospital beds, and ensure efficient intake workflows is going to be crucial. New variants could also exacerbate existing healthcare staffing shortages, which is a major concern for providers whose capacity is already at a “tipping point.” With a winter flu season “twindemic” looming on the horizon, and more people traveling over the holidays, this challenge may only get tougher. One route through this uncertainty is to continue the digital pivot seen in the early days of the pandemic. Here, we look at how flexible self-scheduling tools and other digital services can continue to help providers maintain operational efficiency as they navigate the implications of this new coronavirus strain. Uncertainty about Omicron – and future variants –  could trigger patient scheduling complexities The new variant could trigger a rise in patient numbers, as seen with the Delta variant. In parallel, some providers and states may follow New York’s lead to try to manage non-urgent care and postpone certain elective treatments. Patients, too, may decide to hold off on booking appointments if they’re worried about contracting the virus while visiting their doctor. This means that the scheduling (and rescheduling) challenges seen throughout the pandemic could resurface. Providers should be ready to offer easy and convenient self-scheduling options. Digital patient scheduling platforms allow patients to book essential care and reschedule deferred appointments from the comfort of their own home, using whatever channel suits them best. Not only will this ease pressure on busy staff and reduce the number of people sitting side-by-side in doctors’ waiting rooms, but it’s also a quicker and more reliable way for patients to plan their care. Providers can augment these operational efficiencies with digital scheduling and registration tools. Registration Accelerator can reduce the burden on patient access teams by allowing patients to create user profiles and fill out pre-treatment information from home. Double down on convenient vaccination scheduling New variant outbreaks also add a layer of urgency and complexity to the ongoing vaccination program. Boosting the country’s vaccination rates is a crucial defense against existing strains of COVID-19. Patient-friendly digital scheduling tools can make it as easy as possible for people to arrange an appointment, thus helping to bump up vaccination rates. Of course, if more people are encouraged to seek vaccinations and boosters, the scheduling process could get even more complicated. Again, digital self-scheduling tools can ease the pressure, by using real-time databases and automation to ensure that patients book appointments within the requisite vaccination window. Automation can also be used to deliver personalized patient outreach reminders, nudging patients to schedule their vaccine appointment if they haven’t made one already. Comprehensive consumer data can help identify the most appropriate messages and channels for different patients, to make it as easy as possible for them to plan and book their appointment. The federal response to new outbreaks has included provisions for vaccine outreach campaigns and education initiatives. Providers should consider how their own outreach campaigns are performing, as well as ensure that their scheduling platforms are ready to meet the increase in demand that’s likely to follow. Automation and digital scheduling tools could help alleviate staffing shortages Behind the scenes, providers are still wrangling with ongoing staffing shortages. According to an analysis of US Bureau of Labor Statistics data, hospital employment declined by nearly 100,000 between February 2020 and September 2021, amounting to a financial cost of around $24 billion. New variants could make this worse. If more staff are infected, healthcare organizations may find it more difficult to handle the increase in patient volume. Automating manual tasks can free up capacity by helping to manage the growing demand for services and reduce call volumes. These automated tools and systems are designed to be user-friendly for busy staff, and for patients looking for a stress-free patient access experience. With streamlined self-scheduling options and more efficient staff workflows, providers can feel more prepared in the face of uncertainty. Contact Experian Health to find out more about how digital scheduling tools can help your organization prepare as the Omicron situation unfolds.