Tag: collections

Consumers can order groceries or rent a car with just a few clicks, so paying for medical care often feels frustratingly complex in comparison. Bewildering pricing information and limited payment options leave patients with a poor impression of their healthcare experience, no matter how good their clinical care is. If patients are confused about what they owe and how to pay, they’ll end up missing payments and even delay care. Creating streamlined billing and payment processes and automating patient payments makes life easier for patients and providers, especially as they shoulder more healthcare costs. Here are 6 reasons why providers should consider automating patient payments with tools like PaymentSafe®, to increase patient satisfaction and accelerate collections. 1. Customized payment options One of the top reasons to automate patient payments is the ability to deliver a personalized experience to each patient. No two patients have the same financial situation, employment circumstances or desire to use digital technology. Why expect them to thrive with a one-size-fits-all billing and payment solution? Automated patient payment services draw on multiple sources of data to generate individualized insights at a scale, speed and level of detail that would be impossible manually. For example, Patient Payment Estimates produce instant, pre-service cost estimates based on the patient’s specific care requirements and coverage. It pulls in real-time payer rates and provider charges to make sure the patient has an accurate estimate from the start. By giving patients accurate, timely and relevant billing information and payment options, providers can increase collections earlier in the revenue cycle and meet patient expectations for a convenient consumer experience. 2. Reduced operational costs The longer a patient bill goes unpaid, the less likely it is to be recovered in full. Each additional billing cycle adds to the cost to collect. Staff must spend more time making outward collections calls, handling billing queries and issuing monthly billing statements. Automating patient payments eliminates much of this expensive extra work and reduces overall collections costs. Providers can automate manual tasks such as checking for charity eligibility or clearing up patient records, as well as, leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter. 3. Timelier patient payments The common denominator in these automated payment solutions is that they all help patients clear their balances sooner rather than later. Patients can move on with their lives without bills hanging over them, and providers will see a healthier bottom line. With convenient and compassionate tools, each patient encounter can be an opportunity to collect. For example, PaymentSafe® enables providers to accept secure payments anywhere, anytime, using eChecking, debit or credit card, cash, check and recurring billing, through a single, easy-to-use web tool. A connected healthcare collections ecosystem can deliver the data needed for pre- and point-of-service payments, including insurance verification, patient responsibility assessments, financing options, and payment methods. 4. Better balance management According to Experian Health and PYMNTS data published in July 2022, nearly half of consumers who canceled appointments last year did so because of cost concerns, while a fifth spent more on healthcare than they could afford. Making bills manageable with automatically generated payment plans will take a huge weight off their shoulders. And in another joint report, Experian Health and PYMNTS find that patients welcome more flexible ways to spread out the cost of care. Financial stability seems to influence whether patients embrace payment plans. Of those living paycheck-to-paycheck, patients who struggled to pay bills were twice as likely to use a payment plan than those who did not struggle to pay bills. However, lower-income patients may be underutilizing payment plans, as 9% had yet to pay the bill from their last visit. Manually setting up payment plans can be time-consuming and tricky to get right. Patient Financial Clearance automatically calculates the most appropriate and affordable payment plan for each patient, based on their individual financial situation. Those that are likely to be able to pay upfront can be encouraged to do so, otherwise, they can pay in more manageable chunks. Read the report: “Managing Healthcare Costs: How Patients are Using Payment Plans” 5. Reduce the risk of errors A significant downside to manually managed patient collection processes is that it’s all too easy to replicate errors. Patient information may be outdated, causing statements to be mailed to the wrong address. Active insurance may be undisclosed, leading to missed opportunities for reimbursement and higher patient bills. Inaccurate financial or employment data may prompt staff to chase accounts that have a very low chance of being paid. In short: errors are expensive. Automation solves these challenges. Coverage checks, pre-authorizations and eligibility verifications can be completed automatically, giving providers and patients greater confidence in billing breakdowns. Error-free billing means patients are more likely to pay their bills sooner, saving providers time and money across the entire revenue cycle. 6. Improve patient experience Ultimately, automation helps providers deliver a more streamlined, secure and satisfying patient experience. Experian Health’s State of Patient Access 2.0 survey found that more providers were offering alternative payment methods and upfront billing estimates to make payment easier for patients. They were also introducing payment options at the start of the patient journey, which gives patients control over how and when they pay, and minimizes the risk of late and missed payments. Patients feel empowered when they have more control over their healthcare spending; when they are unsure about what they owe or how they should pay, payments will take much longer. This is about more than prompt payments: 6 in 10 patients who received an unexpected bill or inaccurate estimate say they would switch healthcare providers for a better payment experience. Automating patient payments is table stakes These are just a few examples of the advantages of using automated payment services for patients. Patient demand for convenient and flexible digital payment methods is not going anywhere. Providers must keep pace or risk patient attrition later. Digital processes can make the collections team’s jobs easier and more satisfying and are viewed as a way to retain staff as managers continue to address the many challenges that remain from the pandemic and now, inflation and economic uncertainty. Experian Health’s suite of healthcare collections solutions is designed to be user-friendly to minimize training requirements, and collections consultants are on hand to support whenever needed. Tips to maximize the benefits of automating patient payments When choosing a patient payment solution, providers should look for ones that: use robust data sources offer tracking and reporting tools come with adequate training, support and service-level agreements deliver a seamless experience for patients in alignment with client product offerings. Collect payments anytime, anywhere, with Experian Health’s PaymentSafe®, the automated payment processing solution that helps you increase collections earlier in the revenue cycle and avoid bad debt.

Healthcare can be a serious expense. Around half of U.S. adults find it difficult to keep up with the costs, according to research from the Kaiser Family Foundation. As a result, roughly 4 in 10 have delayed medical care or gone without it over the last year. That’s where patient payment estimates and price transparency come in. When discussed at the outset of care, it can help patients prepare their budgets and understand their payment options. Consider it a built-in opportunity for healthcare providers to increase patient satisfaction and collections. “We’re all patients, so we all know the struggles,” said Riley Matthews, Senior Product Manager at Experian Health. “There is real frustration when faced with personal health challenges. On top of that, you’re burdened with meeting financial responsibilities. There’s no upfront explanation or seamless user experience to guide you through the cost of those services.” How to approach patient payment estimates The best time to share cost estimates is before the patient receives care. Healthcare providers can frame it as a two-way conversation, where the patient can ask questions and understand their projected out-of-pocket costs. When pricing is unclear, the patient might forgo care altogether. That’s a lose-lose for both the patient and the provider. Price transparency tends to lead to a better patient experience. According to a recent study conducted by PYMNTS and Experian Health, those who aren’t aware of their financial responsibility beforehand are less satisfied than patients who are. It then comes down to calculating patient estimates that are accurate and reliable. Patient Payment Estimates from Experian Health provide a clear breakdown of their out-of-pocket costs for the recommended services. It’s a simple but empowering thing that can help patients feel more in control. When patients are engaged and know what to expect financially, providers are more likely to collect payments in a timely manner. The Patient Payment Estimates platform offers: Price transparency, including financial assistance options An improved patient experience that allows for mobile payments Increased point-of-service collections Helping patients understand their payment options Once patients have a clear cost estimate, you can shift the conversation toward their payment options. Some may prefer to pay their bill in full beforehand. Others may need a more flexible arrangement — otherwise, they could opt out altogether and seek better payment options elsewhere. According to the PYMNTS and Experian Health study mentioned earlier, nearly one in 10 patients used a payment plan for their most recent doctor’s visit. What’s more, many patients who use payment plans are highly interested in switching providers if it means a better payment experience. Payment plans are valuable because they bend to fit patients’ unique financial situations. They can also increase the collections rate for healthcare providers. Experian Health’s Collections Optimization Manager can help providers be more intentional with their collections strategy. It scores and segments patient accounts based on which ones are most likely to be paid. From there, it directs them to the right resources to make payments. It essentially uses account data to bump up collections. Giving patients what they want Experian Health’s State of Patient Access 2.0 survey drove home an important point for healthcare providers — patients want clear, transparent pricing, along with payment plans and easier ways to pay. It’s precisely why patient-centered payments are so important. The idea is to give patients realistic financial expectations and fast, convenient payment options. Doing so can increase patient loyalty and revenue. Online patient payment software answers the call. This type of patient-first digital solution can optimize communication between patients and providers and allow for simple online bill pay. Patients are managing much of their finances online these days, from their bank accounts and student loans to their mortgages and credit cards. PatientSimple is a secure online portal where patients can set up payment plans, update their insurance information, schedule appointments and more. As the healthcare industry evolves, the patient experience is growing right along with it. Digital solutions, which make room for transparent pricing, are part of that journey. Patient Financial Advisor is a prime example. It provides an accurate snapshot of costs and payment options in advance. Patients receive a personalized estimate based on their benefits information and the provider’s payer contracted rates and pricing. Patients are also directed toward secure payment options. When all is said and done, healthcare providers want to deliver excellent care while also hitting their revenue goals. Patient payment estimates can be a driving force in getting there. Discover how Experian Health can help healthcare organizations provide price estimates and create better patient experiences.

Healthcare providers that fail to embrace automation and digital tools to optimize patient collections could be leaving money on the table. Patient financial responsibility is higher than ever; however, the number of patients that struggle to pay is increasing, with 3 in 10 patients saying they’d be unable to pay a $500 bill and nearly a fifth of patients with medical debt believing they would never pay it off. As patient payments account for a growing portion of revenue, providers cannot afford to rely on subpar collections processes. Manual and paper-based patient collections remain the standard for many providers, but the reality is these outdated methods are unreliable and inefficient. Billing is slow and vulnerable to errors, and staff loses valuable time to the many pitfalls of paperwork. Optimizing patient collections with data-driven automation and user-friendly digital tools is a much smarter approach to accelerating payments, improving recovery rates and reducing operating costs. Why providers need to optimize patient collections Collecting patient payments has long been a pain point for providers. Recent changes sweeping across the insurance landscape and economy have exacerbated the challenge. More patients are turning to health plans with higher deductibles, which may seem more affordable in the short term, but leave patients footing a greater portion of their healthcare bills overall. At the same time, these bills – along with most other household expenses – are increasing at a rate that outpaces salary growth. For providers, this raises the risk of uncompensated care. Until recently, most write-offs in patient collections were associated with uninsured patients, but the uptick in high deductible health plans has nudged the burden of debt toward insured populations. Rather than waiting until the final bill has been determined and then mailing out a billing statement to the patient, providers must shift their focus to the earlier stages of the collection process. If they can calculate exactly how much each patient owes and route their account accordingly, collections will be smoother and faster. The task of calculating patient financial responsibility is complex, though. Applying automation technology to tackle this challenge is no longer optional. Benefits of automating patient collections The digital revolution accelerated during the early stages of the COVID-19 pandemic. Scheduling and registration – which lay the groundwork for efficient patient collections – were managed through remote online self-service tools, while contactless payments became commonplace. The drivers of data and automation may have shifted now, but the benefits remain clear. Aside from the financial savings associated with transitioning to fully electronic transactions, automation facilitates operational efficiencies. Automation can counter staffing shortages in patient collections teams, by helping staff focus on the accounts most likely to pay. They can filter out bankrupt or deceased accounts and use automation to check charity eligibility. Automated dialing and texting can be used for more efficient patient communications. Optimizing billing and payments can also create a more compassionate experience and make it easier for patients to understand what they owe and how to pay, without the need for endless phone calls to patient collections teams. Providers should consider the following five steps to leverage data and automation for improved patient collections: Step 1: Establish clear financial policies for patient collections Streamlined collections begin with clear patient communications. Patients should be advised of payment policies as early as possible. For example, does a particular type of appointment have to be paid for at the point of service? Could they be eligible for a discount if they pay a larger bill sooner? When patients are fully informed of their financial obligations, it’s easier for them to plan. Automated upfront Patient Payment Estimates give patients an accurate idea of what they’re likely to owe, reducing the risk of missed or delayed payments. Automated data analytics can help providers tailor patient communications based on the patient’s preferred method of communication and offer the most relevant information when it matters most. Step 2: Prioritize point-of-service payments to optimize patient collections The longer a bill sits in accounts receivable, the less likely it will be recovered in full. Encouraging patients to pay as much of the bill as possible, as early as possible, helps improve recovery rates. This starts with verifying the patient’s insurance coverage. Giving the patient clarity about their coverage, co-pays and deductibles at the time of service reduce payment delays and confusion. For the Director of Patient Financial Services at Kaiser Permanente Northern California, applying automation in this way has helped staff and patients navigate a more complex coverage environment and drive up point-of-service payments: “At Kaiser, we’ve implemented financial assistance patient identity verification tools to help us identify what our members would be able to pay at the point of service, and how we would manage them on the back end if they end up with a patient balance. Before we had these tools, we were blind as to what our patients would be able to pay.” Step 3: Give patients personalized payment options Offering a choice of payment methods that patients can access anytime, anywhere, can also increase point-of-service payments. Patients repeatedly say they want flexibility, having grown accustomed to the digital and contactless payment methods used in everyday retail scenarios. Experian Health’s Patient Payment Solutions enable providers to accept multiple forms of digital and contactless payments, including eChecking, credit and mobile payments. Patients also welcome the option to spread out payments and set up automatic recurring payments to manage larger balances. Providers can deliver a more satisfying patient experience and accelerate collections by offering personalized payment plans. Data and automation help providers identify and deliver the best-fit options for each patient. For example, PatientSimple is a consumer-friendly self-service portal that identifies the best financial pathway for each patient and allows them to pay balances with ease. It also stores payment information so patients don’t need to input their card details every time they want to pay. Step 4: Use smart strategies to pursue bad debt Determining the best collection approach for each patient requires current and comprehensive insights into their financial situation. Collections Optimization Manager pulls together data to help providers prioritize accounts by payment probability. Communications regarding accounts with a high payment probability can be automated and managed through self-service options. Accounts that are less likely to be paid can be routed to collections agencies or managed in-house, to increase workforce productivity. Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, explains how automated collections insights reduce bad debt: “We’re able to extract data from the 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 allows the client to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.” Step 5: Train staff to have compassionate conversations Finally, with the right data, staff can have more compassionate and useful conversations with patients about how best to manage bills. Medical debt is a growing concern for patients, and staff should be trained to handle these conversations sensitively. Providers can further maximize their collections strategy by training staff to use collections optimization software to its fullest potential. Staff may worry about the learning curve when transitioning from paper-based to digital processes. Experian Health’s Collections Optimization Manager is designed with a user-friendly interface for intuitive navigation. Staff can easily view reporting and benchmarking insights and identify opportunities to improve collection rates. Find the right revenue cycle management partner With support from a trusted revenue cycle management company, providers can improve patient payment collections for increased revenue and streamlined operations. Speak to Experian Health today to find out how our best-in-class solutions are helping healthcare providers optimize patient collections, reduce bad debt, boost recovery rates and deliver a stand-out patient financial experience.

According to the most recent figures from the Centers for Disease Control and Prevention, around 8.8% of Americans are without health insurance. While this has dipped since the pandemic high of 10.3% towards the end of 2020, it still leaves nearly 30 million people facing the often-difficult decision of what to do when they need healthcare. A further 40 million underinsured individuals could find themselves in the same position.  Do they pay for it themselves, avoid care altogether or seek financial assistance? With inflation on the rise and government pandemic support coming to an end, even those with coverage may need additional charity care support. Several regulatory efforts have been made to address healthcare affordability and increase transparency around charity care, particularly at the state level. For providers, the challenge is to find efficient ways to screen for charity care eligibility as more patients become eligible for support, and remain compliant as these new regulations come into effect. Why screen for presumptive charity? Eligibility for charity care depends on a hospital's financial assistance policy and relevant state regulations. Uninsured patients may be offered a full or partial discount on their medical bill, while insured patients may be awarded a discount on the cost of care. Without charity care, these unpaid bills would be tagged as bad debt, which could lead to patients being chased for payments they're unable to make and affect the provider's cash flow. To qualify for charity care, patients are often asked to share their household size and income, among other details. Often a provider will ask patients if they'd like to fill out financial assistance forms during patient intake, but many patients decline or are unable to provide the necessary information. Some may feel embarrassed about needing support or worry about how the information will be used. There may be language or literacy barriers. Some may assume they're not entitled to support and decline the forms. To get around this, providers use automated screening software to identify patients who may be eligible for charity care. This pulls together credit information, demographic data and financial details to determine whether the patient qualifies. Patients get the support – and thus the care – they need, and providers can focus their collections efforts on those who are most likely to be able to pay. Regulation 501(r) permits this type of presumptive screening by a reputable third party. What does the legislation say about charity care? As the use of presumptive eligibility screening has grown, several federal and state regulations have been introduced to encourage clarity, consistency and best practice. Providers must keep pace with changes to charity care policy or risk civil penalties or the loss of tax-exempt status. Under the Affordable Care Act, Regulation 501(r) requires hospitals that offer charity care to have a written financial assistance policy, specify maximum amounts that eligible patients can be charged, and determine a patient's eligibility before sending their bill to collections. Again, it allows for this process to be automated using a third-party vendor. Individual states also have their own requirements around eligibility screening, for example: In Washington, the legislature has recently voted to expand charity care eligibility as of July 1 2022 for patients who meet federal poverty level thresholds and have exhausted third-party coverage options. The new rules require hospitals to identify patients that might be eligible for retroactive Medicaid support and support them in applying for coverage. In California, the AB 1020 rule raises the income level for charity care eligibility to 400% of the federal poverty level. Hospitals must display online notices explaining their policy for financially qualified and self-pay patients. They must also wait 180 days before assigning unpaid patient bills to collections, and provide information to patients before doing so. AB 532 requires hospitals to give patients written details of patient charity care and discount policies at the time of service or at least before they are discharged. How can providers streamline the presumptive screening process? Automated presumptive screening can help providers comply with these new rules and implement their own financial assistance policies in the most efficient way. For example, Experian Health's Patient Financial Clearance uses current financial data to screen patients for Medicaid, charity care and other financial assistance programs in line with the provider's unique charity policies. It incorporates customizable logic that helps providers adhere to regulatory requirements and internal rules around charity care and billing. Screening happens automatically prior to or at the point of service, generating an estimated Federal Poverty Level (FPL) percentage for each guarantor.  A healthcare-based propensity to pay score can also be calculated, giving providers a further data point to work best with patients. This makes it easy for patient advocates to connect patients with the most appropriate financial assistance program, and even auto-enroll them. If the patient does have an amount to pay, they can be guided to the optimal payment plan for their individual circumstances. Patients can get direct access to screening qualification tools too, with solutions like Patient Financial Clearance. They can check their qualification status and upload documentation to qualify for discounted or free care via text to their mobile device. In addition to helping providers ensure regulatory compliance and document charitable services, this tool helps maximize collections and deliver a patient-centered financial experience. Providers should also check that their collections partners are aware of their obligations under charity care law, and ensure they're compliant, too. Keeping patients in the loop during charity care eligibility screening Clear communication is at the heart of a compassionate patient experience, fostering loyalty and trust. In the context of charity care screening, this means making sure that patients know that financial assistance may be available (now also a requirement under charity care regulations). In the past, some patients were not informed about how to apply for financial assistance and struggled with bills they couldn't afford. Others were assigned to charity care without their knowledge and spent months worrying unnecessarily about bills that would never arrive. Automated charity care checks solve both situations, by ensuring that no patient misses out on support to which they're entitled and by making it easy for providers to notify them. Patient Financial Clearance generates scripts for patient advocates to use during financial counseling discussions, to help patients navigate the financial process with greater ease. And with mobile text charity screening, the patient gets the information they need, right in the palm of their hand, so they can engage with the process more easily. Patient Outreach solutions can complement these activities by providing timely and personalized prompts and reminders through the patients' preferred communication channels. Not only will this enhance the patient experience and support compliance with charity screening rules, but it also helps improve patient outcomes by keeping patients on track with their care plans and driving down unnecessary readmissions. And for patients who do have an amount to pay, a payment experience that's tailored to their financial circumstances will further boost patient satisfaction and collections. The ROI on these tools can be significant. Let's say a hospital treats 1,460 uninsured patients per month. If just 10% of those patients qualify for Medicaid, at an average reimbursement rate of $1000, the hospital could claim $146,000 per month by ensuring those patients are enrolled – and avoid writing off nearly $1.8 million per year. As economic uncertainty continues to weigh on providers and patients alike, the pressure's on to streamline patient collections and prevent avoidable missteps such as non-compliance with charity care rules. Find out how using an automated financial assistance process with Patient Financial Clearance can create a safety net for providers and patients, increase collections and reduce bad debt as patient financial responsibility increases.

New research from Deloitte reports that healthcare costs for the average American could jump from $1000 to $3000 per year by 2040, putting pressure on households that are already feeling financially squeezed. Concerns about healthcare bills could push patients to delay or even default on payments. With inflation on the rise, providers must find ways to create a compassionate financial experience for patients to maximize collections. That's where Patient Financial Clearance comes in. While inflation and economic pressures are systemic challenges, the impact is individual. This should galvanize healthcare providers to find out exactly how patients may be affected. Using that knowledge, providers can then tailor the financial journey to make it as straightforward as possible for patients to manage their healthcare bills, whatever their specific circumstances. With data on patients' ability and likelihood to pay, providers can tailor charity care checks and maximize collections by building a collections process with the patient at its heart. Create a compassionate collections experience with Patient Financial Clearance Improving patient collections starts with identifying patients that are unlikely to be able to pay and checking their eligibility for extra support. Traditionally, providers might use manual processes to calculate a patient's propensity to pay or entitlement to financial assistance. This might involve asking the patient to fill out a form with their financial details, calling the patient and the patient's employer multiple times to understand their income, manually checking their information against the Federal Poverty Level to see if it meets the threshold for full or partial charity support, and then having the patient fill out yet more forms. Such labor-intensive work is a drain on staff resources, and often a stressful experience for patients. Patient Financial Clearance helps create a more positive financial experience by automating eligibility checks. That way, patients can be assigned to the right payment pathway without delay. This solution also empowers patients with mobile text-based financial screening and provides them with updates on their charity status. It uses current financial data to screen patients to see if they're eligible for Medicaid, charity support or other financial assistance programs, prior to or at the point of service. Armed with this data, providers can offer the best possible support to these patients and even auto-enroll them in the right program. For those with medical bills, Patient Financial Clearance calculates an optimal payment plan based on how much the patient is likely to be able to afford, so patients are clear about what they'll owe and when. It can also suggest upfront fee collection when a patient can afford to pay but has been historically slow to do so. Personalizing the payment pathway with digital financial solutions Making sure patients don't miss out on financial assistance is just one way to use data and automation to personalize the payment process. Data-driven personalization should be a thread that runs through the entire financial experience, including: 1. Personalized upfront payment estimates Price transparency remains high on the agenda. Patients want to know their bills in advance so they can plan. Surprise bills lead to delays and frustration, to the detriment of both patients and providers. With Patient Payment Estimates, self-pay patients can generate personalized pre-service cost estimates so they can get their financial ducks in a row before treatment even begins. These estimates are based on the patient's individual insurance status, current payer rates and the provider's chargemaster data. The tool also incorporates any applicable financial assistance, applies prompt-pay discounts, and suggests convenient payment plans that fit the patient's individual circumstances. 2. Tailored payment plans for all Once the patient has their estimates, they'll want to know exactly when and how to pay. Some will be able to pay the full amount upfront, while others may need to spread out payments into more affordable chunks. Providers can maximize swift collections by ensuring that individual patients are directed toward the most appropriate option. Oftentimes, it may make sense to collect more payments upfront to alleviate collections costs downstream. One way to deliver this is through a self-service portal such as PatientSimple, which provides a one-stop-shop for patients to view their estimates, consider pricing plans and keep credit card details on file. Being able to plan in this way gives patients more control and avoids any confusion about payments. 3. Consumer-friendly payment methods When it's time to pay, patients want options. Not everyone wants to come into the office, send credit card details in the mail, or exchange details over the phone. Online payment portals, contactless payments and mobile wallets are increasingly popular. Therefore, providers need to offer convenient digital payment options to remain competitive.Offering a menu of payment options early in the patient journey means patients can “frontload” their financial admin, get payments out of the way, and focus on medical treatment. By giving patients control over how they pay, providers can reduce the risk of late and missed payments. 4. Timely and relevant communications If there's one action that can make or break a patient's perception of their financial experience, it's how their provider communicates with them. If information about medical billing is accurate, timely and compassionate, then the patient will feel more positively than if messages seem aggressive or contain errors. Getting this part right will improve patient engagement, drive faster patient collections and boost patient loyalty.Healthcare marketing data can be used to underpin a personalized communications strategy and help providers send the right message at the right time, based on the patient's preferences. When it comes to delivering the message, patient outreach solutions can send automated text and voice messages with bill reminders and links to payment methods to encourage prompt payments. Use Patient Financial Clearance to automate patient financial assistance Building a patient financial experience around the principles of personalization, empathy and convenience puts providers in a stronger position to maximize patient collections than with a one-size-fits-all approach. Find out how Patient Financial Clearance and other digital patient financial solutions leverage data and automation to identify and deliver what each patient needs, to improve patient satisfaction and increase the number of bills paid in full.

Dayton Children’s Hospital is a pediatric hospital in Ohio with over 300,000 annual patient visits. Ranked by U.S News & World Report as one of the top 50 pediatric facilities in the United States, the facility’s mission centers around providing “optimal health for every child.”  Challenges The Patient Accounts department, led by Richard Gonzales, wanted to reduce his team’s reliance on third-party collections agencies and avoid associated fees. This meant that his in-house team needed to further scale its operations and processes to reach their in-house collections goals. The Pre-Service Operations department, managed by Jason Schenck, pursued efficiencies for resources within the centralized scheduling team, including the goal to quickly respond to referrals and turning those referrals into scheduled appointments within 24 hours. Throughout the pandemic, both teams experienced staffing shortages and pandemic-related absences. Because their dialing methodologies were manual, these disruptions in personnel prohibited them from growing in-house collections and reaching the turnaround times Schenck's team wanted to achieve for scheduling referrals. As Dayton Children’s strived to achieve these ambitious goals, they decided to proactively provide a better patient experience through convenience, connection and an effective communication experience. Resolution Dayton Children’s launched Experian Health’s PatientDial solution in the Patient Accounts department to scale their in-house collections efforts, thereby reducing dependency on their outside collections agencies. The solution was also adopted in the Pre-Service Operations department to automate dialing and conversation readiness so that the team could expedite the scheduling of referred patients. The expertise of a dedicated Experian Health consultant provided unwavering support to the two departmental heads and also gave them full control over the operations to best match their expectations. Streamlining patient payment collections with PatientDial  The Patient Accounts department’s operations revolve around billing a claim, reducing bad debt, increasing patient collections and providing effective customer service. They devised a two-pronged approach when it came to contacting patients for payments. The outbound campaign focused on collections, whereas the inbound customer service team handled the large volume of incoming calls from customers and rerouted them to the correct department. When it comes to collections, the Patient Accounts department found that making phone calls was the most effective medium to support their collections efforts. Billing is a complex process and taking the time to connect with patient guarantors to explain those bills paid off. To refine the communication approach, patient accounts were segmented based on outstanding balance amounts and where they were on the statement cycle. Calls were then made to the accounts with the highest propensity to pay. Waiting on hold not only wastes a patient’s time but also leads to a frustrating patient experience. Many even abandon calls, to call again later, which makes phone lines even busier. To provide a better patient experience, the department was also able to try out an innovative recall campaign, enabled by the queue callback feature. Patients were called back automatically the moment an agent became available, thereby reducing call hold time. By providing patients with this callback option, Dayton Children’s is empowered to accept more inbound calls per day along with having empathetic conversations with guarantors around payment plans to sustain its collections goals. Patient scheduling and preregistration powered through automation The Pre-Service Operations department leveraged PatientDial to improve outbound call efficiency and optimize existing staff resources to schedule appointments rather than leave voicemails. The productivity for scheduling a new patient visit from an outbound call was about 30%. With the centralized team supporting more than 40 specialty clinics, the team needed to improve the number of new patient visits scheduled daily, which meant opening resources to receive inbound calls. The mighty team of 10 was able to strategically use the autodialer feature to make new appointments, send appointment reminders and schedule referrals. Time is of the essence in a healthcare setting, and swift access to pertinent patient information enabled the staff to start their work even before greeting the callers when an inbound call came. Powered by the agent pop feature, staff had immediate access to key patient identifiers such as name, date of birth and specialty clinic from referral. Additionally, the feature enabled the team to reinvest time in creating a positive patient experience through improved hold and talk times, both of which reduce the risk of call abandonment. Results of incorporating PatientDial With PatientDial, the Patient Accounts department has been able to successfully align revenue goals with employee productivity. Previously, the staff was able to make only 50–60 calls per day, out of which 70% went unanswered. By automating dialing, the staff is now able to make 600 calls per day, resulting in a corresponding uptick in collections. The recall campaign, used for following up with patient guarantors, was a new endeavor for the department and has reduced the staff’s burden of making 300 manual calls per day and has also reduced call abandonment rates. The Pre-Service Operations department, has seen a 50% increase in patient appointments scheduled, powered by 600–800 automated calls made per day. The referral-to-scheduled appointment timeline has gone down from 4 days to under 1 day. Two hundred patients can now be reached via text daily and the speed to answer calls has been reduced from 60 seconds to 30 seconds. Lastly, PatientDial has positively challenged the Pre-Service Operations department to rethink productivity and daily operational efficiency. Dayton Children’s investment in dialing automation has streamlined their patient communications around scheduling and far exceeded initial goals. Because of the resulting high volumes of new patients scheduled and improved efficiency and effectiveness the team realized, there’s a strategic plan specific to central scheduling and to implement standard processes for managing new patient referrals across the organization. What’s next for Dayton Children’s? Empowered by their stellar results, both the Patient Accounts and Pre-Service Operations departments want to further explore how PatientDial could help other departments achieve greater productivity and further deliver a positive patient experience. The Patient Accounts department wants to maintain its focus on productivity gains and employee experience through PatientDial, with the ultimate goal of bringing in more collections. The Pre-Service Operations department plans to take on additional scheduling responsibilities across departments, creating time to reinvest in direct patient care and improving patient outcomes. Initial plans are for establishing patient scheduling and improving processes to identify and schedule follow-up visits. Both the teams at Dayton Children's recognize Experian Health’s expertise in revenue cycle solutions, which has made this a successful partnership. Learn more about how PatientDial uses patient outreach and patient engagement processes and workflows to increase your bottom line.  

Healthcare revenue cycle challenges exist at every stage of the patient journey, beginning with patient access and extending all the way through claims, billing, payment and collections. However, digital tools and analytics can help providers tackle their top healthcare revenue cycle challenges. “The complexity of our reimbursement structures and the complexity of billing mean a variety of aspects impact revenue cycle management,” says Tricia Ibrahim, Director, Product Management, Contract Manager, Hospital at Experian Health. “Technology, regulations, changing contractual obligations and payer policies, people, processes, billing—each of these complexities adds to the challenge.” Revenue cycle management (RCM) issues can also lead to revenue loss if not addressed. Data and analytics, digital tools and automation can help providers manage complexity and adapt to evolving patient needs. Here are seven of the top healthcare revenue cycle challenges and how providers are taking them on: 1. Problems with patient access Consumers accustomed to using mobile apps and online services to shop and do their banking look for seamless digital experiences when they’re choosing a provider, scheduling appointments and managing pre-appointment activities like registration and insurance verification. In a new consumer survey by Experian Health and PYMNTS, 77% of patients who were not currently using digital tools for healthcare said they would be interested in switching to a provider that offered a patient portal. The automated tools that make up your digital front door make a huge difference in how patients engage. Together with accurate estimates and convenient payment options, digitally focused Patient Access Solutions help providers enhance the patient journey and improve registration accuracy. Manual processes require more staff time up-front; human error can lead to claim denials or billing errors later in the cycle. Automating streamlines the process. Offering patient intake software that can be accessed online or via a mobile device provides the flexible and familiar digital experience they expect in today’s world. 2. Poor collections recovery rate As high deductible health plans have patients taking more responsibility for their healthcare costs, patients are finding it more difficult to pay. Bigger bills often translate into a greater potential for confusion, more questions about insurance coverage, and a greater need for financing options. Providers need effective collections strategies to boost revenue and lower bad debt write-offs as more focus shifts to the patient as a payer. A patient-centered payments strategy helps patients better understand their estimated costs, insurance coverage, and payment options. To help patients navigate the financial process successfully and navigate this healthcare revenue cycle challenge, providers will need to support them with: Clear, accurate estimates that show patients how much they’ll owe up-front Payment options that include multiple payment methods, including cards, Apple Pay, and e-checks Navigating payment plans to manage large balances A process that encourages payment before service or at the point of service to reduce collections down the line When providers have to collect, digital tools and analytics can help optimize the collections process by prioritizing accounts that are most likely to pay, automating billing and messaging workflows, and even tracking the effectiveness of outside collections agencies. 3. Billing errors Claim denials are a drag on workflow, sending staff into a repetitive loop of claims submission, denial, correction, and delay—and throwing a wrench into revenue flow. A denied claim typically slows reimbursement by 16 days. Worse, claim denials are on the rise: 69% of healthcare leaders in an MGMA Stat poll reported that denials increased at their organizations in 2021. Replacing manual processes with automated workflows can reduce billing errors and A/R days. Integrated claims management software reviews claims for inaccurate coding before claims are submitted, easing demands on staff time, reducing claims denials, and shortening the time between billing and payment. 4. Underpayments in payer contracts Missed payments and underpayments can add stress and volatility to your revenue cycle. Often, the source of these problems lies in payer contract issues. “Payers often know your book of business better than you do,” says Ibrahim. “When you’re negotiating contracts, you need to be able to go through large amounts of data quickly and efficiently, so you can come to the table armed with information. One of the services we provide is contract analysis to help providers evaluate contract terms in real dollars and cents.” For active contracts, Healthcare Contract Management helps providers track inaccurate payments and hold providers accountable. 5. Changes in healthcare regulatory and compliance standards New regulations are a constant in healthcare. However, this is one of the biggest healthcare revenue cycle challenges that providers need to keep up with. Failing to stay up to date with the ever-evolving compliance landscape can lead to claim denials, payment delays, and administrative and billing backlogs. Healthcare Regulatory Solutions, which includes systems for providing transparent, patient-friendly estimates, can make it easier to make regulatory compliance part of your regular business processes. A free No Surprises Act (NSA) Payer Alerts Portal keeps providers updated on how new NSA regulations are playing out. 6. Lack of data-driven metrics and insights Gaining efficiencies in RCM means using analytics to provide a big-picture view of what’s happening throughout the enterprise. This perspective is not always the default in a busy healthcare practice or hospital. Yet, “Fixing claim after claim on an individual basis isn’t going to get you the efficiency you want,” says Ibrahim. “You need to identify trends to find the biggest opportunities to improve your results.” Comprehensive data and analytics are key for providers that want to pinpoint and address areas of trouble. Here, disparate systems and siloed information can get in the way of creating the single view needed to diagnose the issues that are slowing down claims, billing, and payment. Revenue Cycle Management Analytics integrates client data with non-native standard Electronic Data Interchange sets to reveal opportunities for process improvements. By leveraging the right data, providers can optimize patient access productivity, billing efficiencies, reimbursements, and payer performance. 7. Potential security issues Patient portals engage patients and empower them to schedule their appointments, review test results, or make payments. But as providers digitalize to improve the patient experience and boost the revenue cycle, patient identities and data may be at greater risk. Cases of medical identity theft reported to the Federal Trade Commission rose more than 532% between 2017 and 2021. Medical identity data is particularly valuable to thieves, bringing 20 to 50 times more money than data from financial sources. Securely authenticating patients is critical as a safeguard for both providers and patients. Identity theft damages the patient experience and erodes trust, while dealing with the resource and reputational damage fraud can cause is a major potential liability for providers. Working with vendors that provide extensive Patient Portal Security and digital tools that protect patient identities without causing friction or frustration is essential to keeping patient data safe without alienating the patients in the process. Prevent healthcare revenue cycle challenges with automation Revenue cycle management healthcare challenges are among the great tests facing providers right now. But improvements in digital tools and analytics are helping providers keep revenue flowing while keeping both compliance and the patient experience in focus. Find out more about how Experian Health's Revenue Cycle Management Solutions can help your organization meet the challenges of modern RCM.

“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.

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.