In the “good old days,” U.S. healthcare was basically free – at least that’s what patients with a good insurance plan believed. You may have had a small co-pay, but if you were employed, chances were that you and your family received comprehensive health insurance that took a barely noticeable bite out of your paycheck. Fast forward to 2014, and that rosy picture is long gone. Changing reimbursement models are compounding the financial risk for healthcare providers by placing a greater payment burden on patients. For example, a growing number of employers are adopting high-deductible health plans (HDHP) and/or health savings accounts. The number of people with HDHPs has risen from 19.2 percent in 2008 to 33.4 percent in 2014, as reported by the Centers for Disease Control and Prevention. Out of necessity, providers are finding themselves in the collections business if they are to protect the bottom line. One of the best tools at their disposal to increase full and fair payment for healthcare services, and which has long been employed by collections agencies? Data and analytics. Real-time information and advanced data and analytics can help identify the most effective and customized collections approach based upon each patient’s financial situation. This data gives healthcare organizations the full picture of a patient, providing continuous monitoring of unpaid accounts for changes in a patient’s ability to pay. Obtaining and effectively leveraging that information is just one best practice for healthcare organizations seeking to enhance their collections methodologies. Additional must-have strategies include: Management of internal collections and agency performance with real-time dashboards and reports, and support evaluation and performance improvement.  Use of full-time revenue cycle consultants and data analysts, who work with each account to recommend “best practice” collections and outsourcing strategies, evaluate reports for opportunities and oversee champion/challenger scenarios.  Tools that help detect hidden or additional insurance coverage from Medicaid, Medicare and commercial accounts.  Creation of customized patient statements that go beyond traditional statements by facilitating financial counseling, education and greater patient engagement.  Simplified and streamlined payment processes by collecting patient open balances anywhere and at any time through eChecking, signature debit, credit, recurring billing, cash, check or money orders.  Times may be changing, but employing a well-coordinated, proactive approach to addressing the self-pay patient and capturing the balance after insurance has paid doesn’t have to be challenging. Learn how Experian Health and Passport’s patient collections tools work together to help you obtain payment certainty even with today’s new reimbursement models, by combining unmatched insight, real-time data and innovative collections solutions.

Meet Joe—a patient who is walking into a healthcare office, terrified of the news he might hear. He is confused and overwhelmed, not sure of where to turn for help. Joe isn’t entering a doctor’s exam room – he is actually walking into a hospital’s patient registration area, waiting to receive information about how much his procedure is going to cost. Although anxious about the procedure, Joe is even more concerned about its impact on the family budget, unsure of his insurance co-payment or what will be covered. He’s worried that he can’t afford to pay a large bill in one payment. His interactions with the registration staff over the next few minutes will set the stage for the remainder of his experience with the hospital. Now, let’s say the hospital realizes the value of having caring and compassionate financial conversations with patients at the start of the patient visit. Patient access staff quickly become the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. In this instance, leveraging a data-driven approach allows staff to verify Joe’s identity and insurance coverage as well as provide an accurate estimate of his payment responsibility. The staff even can review data to assess his ability to pay and evaluate various payment plan and/or financial assistance options. Even after Joe is discharged, the hospital continues to employ a patient-centered approach to collections, using patient financial data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. Joe’s financial data places his in the “most likely to pay” segment, indicating that he would not receive a payment follow up call until (for example) day 75 instead of the traditional call on day 45. This not only saves staff time and increases successful collections, it also preserves Joe’s satisfaction by eliminating unnecessary phone calls when he is likely to pay. Joe expected the hospital’s clinical staff to be responsive to his medical needs. When he found that the revenue cycle team was equally attentive to his financial needs, his satisfaction with the entire experience grew exponentially. It was fueled by a positive encounter that eased his mind about payment and allowed his to focus on his health. Using this proactive, personalized approach, the revenue cycle team had a major impact on both Joe’s experience and the bottom line. What is your healthcare organization doing to enhance the patient experience? Comment below to share some of your best practices.

Picture this: A movie trailer features a healthcare organization with a newly-minted portal through which patients access their private health information, make appointments and ask questions of their physician. The plot thickens as an unwelcomed guest looks for an identity to steal. With a few key strokes of a predictable password, the thief strikes gold, data is breached and the nightmare begins. From the patient standpoint, the Ponemon Institute® reports nearly 1.5 million Americans were affected by medical identity theft last year. And, those numbers are expected to rise as more hospitals add patient portals to comply with Meaningful Use Stage 2, which requires that more than 5% of all unique patients seen by the provider must be able to view, download, or transmit to a third party their health information. All this to say, organizations have the ability to proactively implement strategies to combat this concerning reality. To mitigate the risk of identity theft via a patient portal, healthcare organizations should consider a strategy to effectively control portal access beyond the basic user name and password. This type of heightened security via tools that combine state-of-the-art identity proofing, risk-based authentication and knowledge-based questions can help securely verify each patient’s identity. Such tools empower healthcare organizations to identify fraud more efficiently than traditional rules-based identity checks. Additionally, they provide the patient with a better online portal experience and greater peace of mind knowing that extra security measures are safeguarding their personal information. Don’t let a potential movie storyline dictate your reality. With industry experts predicting a 221 percent growth in the U.S. patient portal market by 2017, it’s time for healthcare organizations to partner with a trusted expert in fraud prevention to help them implement technologies that securely verify each patient’s identity. How secure is your patient portal?

There aren’t too many situations in which an individual purchases a product or service, but is NOT asked to pay for it right away. Healthcare, however, is somewhat unique in that regard, often avoiding a retail-based experience where patients receive service, but pay quite some time later, whether in full or the balance. Not surprisingly, this approach often times adversely impacts healthcare organizations in many ways. Best-case scenario, patient payments, while unpredictable, are received, but not in a timely manner and after a good deal of effort on the collections staff’s part. Worst-case scenario, the organization is left holding the proverbial bag, forced to write off bad debt, when payment could have been received if handled differently. In between, there are poor cash collections, increased revenue cycle costs and lower patient satisfaction. Organizations can avoid this perfect storm with a more precise approach to optimizing patient revenue. By leveraging tools that empower and improve upfront financial counseling communication, healthcare organizations stay one step ahead by accurately predicting patient responsibility payments and enhancing pre-service collections. When fueled by data and analytics, these tools offer a powerful two-pronged approach to minimizing risk and driving revenue: Avoid patient payment delays. Without knowing what insurance companies allow, many providers postpone collections until payer reimbursement is received. Healthcare organizations should instead have access to the latest contract terms, payment rules and fee schedules in order to identify patient and payer responsibility much earlier in the revenue cycle. Increase time-of-service collections. By proactively using patient payment data and current payer contract terms to calculate the amount owed by the patient at the time of service, organizations can effectively collect either a portion or all of that payment upfront. In the end, data-driven estimates of patient payment responsibility allow healthcare organizations to capture more revenue at the right time and boost cash flow. An added bonus is enhanced patient satisfaction because there are no confusing bills or ongoing collections calls, enabling a more personal experience for the patient. Hospitals have an opportunity to use data and analytics to improve the revenue stream and patient satisfaction. Learn about how Experian Healthcare Patient Responsibility Pricer can improve your collections on the front end of the revenue cycle and enhance the overall the patient experience.

We encounter gatekeepers every day, ranging from TSA agents at the airport and call-center operators for online retailers to office receptionists and hotel front desk staff. Gatekeepers have a tough job as they manage access, filter information, provide advice and maintain order. Their attitude and actions dramatically impact our experience as consumers. The healthcare industry must shift from a patient focus to a consumer focus — and it all starts with patient access. Patient access staff act as the frontline — the gatekeepers — as they gather critical patient information at the start of the patient visit and set the stage for the remainder of the encounter. They’re moving beyond simply performing routine registration tasks and collecting co-payments to engaging in a holistic approach to patient interactions. As a result, these critical staff members can create and facilitate compassionate financial discussions while handling revenue-related activities such as pre-service collections. It’s no small task, nor one that can be done without data and analytics. For example, staff can use tools driven by data and analytics to verify patient identity, which prevents fraud and identity theft and results in more accurate registration. Moreover, after reviewing insurance eligibility, patient access staff can leverage data and analytics to create accurate patient payment estimates, review data to assess a patient’s ability to pay and evaluate financial options. The bottom line impact creates a positive environment for financial discussions and improves collections on the front end, while reducing the likelihood of collections calls and bad debt on the back end. Patients benefit in that they gain a sense of confidence — and oftentimes relief — because they know where they stand financially and can focus their energy and attention on getting well. The time is right to establish patient access staff as gatekeepers of the patient experience by equipping them with knowledge and tools to empower them to improve the revenue stream and patient satisfaction.

Remember those commercials for the hamburger chain in the mid-1980’s? An elderly lady angrily shouted, “Where’s the beef?” in response to seeing a tiny burger on a large, fluffy bun. If that same creative concept were applied to healthcare today, perhaps the lady would proclaim, “Where’s the data?” when looking at the revenue cycle. While healthcare as a whole is moving toward using clinical data and analytics to enhance patient care, most organizations aren’t realizing the true potential of financial data to drive revenue cycle performance. So where does that potential lie? Quite simply, it lies in the vast amounts of financial data that healthcare organizations can access, yet do so ineffectively. By leveraging this existing data more appropriately, organizations can build and sustain margins while improving performance and enhancing the patient experience. Consider these three areas of opportunity to use data to drive the revenue cycle. Patient Access Correctly capturing and analyzing patient data at the initial point of contact allows an organization to reap large rewards, both clinically and financially. For example, correct patient identification reduces the risks of fraud and identity theft and ensures that medical records are being provided for the right patient, thus preserving patient safety. In addition, using data to provide accurate estimates of the patient’s payment responsibility up front and developing customized payment plans can elevate patient satisfaction as well as propensity to pay, allowing the healthcare organization to enhance collections and reduce bad debt. Claims and Contract Management Another area of opportunity is in payer contracts and claims. During contract negotiations, data and analytics help identify new service line opportunities for enhanced financial performance. Claims are more accurate and efficient when analytical tools review them before submission, comparing them with contract requirements and kicking out those with errors or ones that require further information. Consider the example of a healthcare organization that improved its recovery rate on denials by almost 50 percent by leveraging data to compare the amount received for the claim with the contracted amount. Collections Data and analytics also can be used to improve internal collections efficiency and profitability. Organizations can use data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. This allows collections staff to prioritize work based on a patient’s likelihood to pay, which improves both collections and the patient experience. For example, a patient scoring in the “most likely to pay” segment may not need a call until day 75, while someone in a lower segment may need additional calls and help setting up a payment plan within the first month. Segmenting in this way not only increases the likelihood of successful payment, it preserves patient satisfaction at the same time. Realize your revenue cycle’s true potential by leveraging financial information to enhance performance. Moreover, marry these activities with efforts to use clinical data to improve care, and you can realize a comprehensive approach to elevating overall quality and performance. You’ll no longer need to ask, “where’s the data?” Learn more about leveraging data and analytics to drive the revenue cycle with this white paper: The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance.

Sometimes it’s all in the cards. And, in the end, it’s usually not a winning hand for the healthcare organization. In this case, the “card” is the patient’s insurance coverage and the “hand” is the increasing amount of bad debt that can be avoided. For example, a patient presents his or her insurance card at registration. The patient’s employer recently changed plans, and the patient mistakenly pulls out the card for the old plan. The claim is processed using the expired insurance information, and the payer rejects it and reclassifies the account as self-pay. After a time, the account goes to collections, and the patient is sent letters and receives collections calls. Both are ignored because the patient has coverage and assumes the provider simply made a mistake. Unable to resolve the issue, the provider ultimately writes the account off as bad debt. When accounts like this one are misidentified, the healthcare organization loses revenue, time and patient satisfaction. Misclassifying accounts can happen because of registration errors, changing insurance or patient miscommunication. When an account is misclassified, it increases the likelihood the account will turn into bad debt, especially when the account is misclassified as self-pay. Even when caught during the collection process, misclassification errors can impact A/R days, payment speed and cash flow. So, how do you play your cards right? Using the most up-to-date payer data, healthcare organizations can systemically search for current commercial, Medicare and Medicaid insurance coverage. An automated process reveals and prioritizes potential active coverage, allowing staff to rectify any mistakes and file claims in a timely manner. Staff can even proactively identify and correct routine data entry errors, such as incorrect birth dates or transposed Social Security numbers, before the claim is submitted. While the organization improves cash flow and productivity, there also are patient benefits. Using data to identify the right insurance coverage upfront makes patient interactions more efficient. In addition, reduced payment misunderstandings and unnecessary collections calls drive overall patient satisfaction. Curious about how your organization can have a winning collections hand? Use data and analytics to improve the accuracy of upfront business processes and enhance the patient experience. Learn about one of our newest products, Self-Pay Coverage Finder℠, and see how automating the search for insurance coverage can positively impact your organization’s bottom line and the patient’s experience.

Americans who do not currently receive health insurance through their employers or a government program such as Medicaid or Medicare are now required to obtain insurance coverage or pay a penalty tax per the Affordable Care Act’s individual health insurance coverage mandate. These consumers can go to newly created health insurance exchanges (HIX) — offered through the state or federal government, depending on where an individual lives — to enroll in a private insurance plan. It’s definitely a patient-driven process. So, how can healthcare organizations help? They can take advantage of this opportunity to improve the patient experience by connecting patients with much-needed insurance, while simultaneously mitigating patient payment risk. Today’s patients want to be armed with as much information as possible. With this new initiative, healthcare providers can help patients navigate the various options offered through the exchanges by calculating how much patients might spend on insurance and by providing a comparison of plan benefits. However, it’s important for healthcare organizations to take this process a step further by screening patients to determine if they qualify for federal subsidies and beginning the enrollment process. Assisting patients in this way not only improves the patient experience, but also benefits the hospital by getting more patients enrolled with insurance, ultimately leading to higher reimbursement for services provided. That leads to the next likely question: how can healthcare organizations successfully aid in this process? Solutions powered by data and analytics are the key. By using a data-driven approach to HIX screening and enrollment, an organization can identify patients that meet the income criteria for subsidy payments and tax credits, and automate the enrollment process by prepopulating the state’s HIX application form. In much the same way that data is used to screen for various financial assistance programs such as Medicaid or charity care, HIX screening uses key information about a patient’s unique financial situation to accurately determine if the patient qualifies for subsidies to help them pay for their insurance. Interested in learning how you can improve the patient experience when it comes to insurance coverage? Check out our newest product, HIX Screening and Enrollment, and see how it can help support your patients as they begin to navigate the new aspects of healthcare reform.

We live in a choice-based society. Every day we are at liberty to make a myriad of choices. like where we live, where our kids go to school, what to eat, whether to exercise, which car we drive or what movie to see. This era of consumerism also means we have choices for healthcare. And since patients now have greater financial responsibility for their healthcare, they are becoming more selective about where they go to receive medical attention, looking not only for high quality but also positive, cost-effective and informative interactions. As patients become choosier, healthcare organizations must improve their commitment to being good stewards of the care experience. To help make things more manageable, many healthcare organizations are turning or already have turned to payment plans to become more patient centric. To that end, industry estimates point to around payment plans being leveraged for one in five outstanding patient accounts, and use of these tools has grown by more than 50 percent in some organizations. While this information may not be news to you, the crux of this approach is that all too often payment plans take “a one size fits all” approach, following a generic formula for all patients without regard to payment history, demographic information or other key financial data. The result? Default rates between 40-60 percent, defeating the overarching goal of reducing patient bad debt. All is not lost! With a data-driven approach to developing patient payment plans, healthcare organizations avoid the common pitfall with a win-win for both patient and organization. By using technology to analyze key information about a patient’s financial situation, an organization can accurately anticipate a patient’s propensity to pay. The technology can then review this information, along with other financial data and organizational policies — such as minimum payment amounts — and generate personalized payment plans that offer optimal terms and amounts. Taking a data-driven approach is a way to extend your organization’s commitment to compassionate care to the billing and collections process. Embracing this method allows business office staff to be responsive to the patient’s unique financial situation, just as the clinical staff is responsive to a patient’s medical status. Leveraging data to develop the optimal patient payment plan helps set the stage for a positive interaction, boosting patient satisfaction and ensuring patients choose your organization as their long-term healthcare destination. Not only does this improve the patient experience, but healthcare organizations are also better able to collect optimal payment in a timely fashion, knowing what each patient can safely afford. Want to learn more about how to develop personalized payment plans that meet the unique needs of patients? We’d be happy to help. Check out our latest product addition, Payment Plan Advisor℠.