Tag: Coverage Discovery

for our upcoming webinar with Banner Health, where attendees will gain insights into the organization's workflow and processes.  It is estimated that 30-50% of denied claims occur on the front end during the patient access process, namely during registration, authorization and eligibility. Unfortunately, manual patient intake processes contribute to these denials, and ultimately, the bottom line, staff productivity and the patient experience take the hit. Banner Health chose to automate its patient access processes with eCare NEXT from Experian Health. The solution, which integrates directly with Banner Health’s acute and ambulatory electronic health records (EHRs), automates the organization’s preregistration workflow, including medical necessity and financial clearance. This improves registration accuracy, provides more accurate patient estimates and reduces the number of denials on the front end. Banner Health has benefited by incorporating a mix of Experian Health products that integrate directly and collaborate with other technologies and workflows already in place: Decrease in eligibility errors. With eCare NEXT, initial denials due to eligibility errors have been reduced by $30M in the first quarter alone since going live with Experian Health. Significant cost savings. With more accurate estimates, Banner Health has seen significant cost savings on the front end from more efficient coverage discovery. The system is consistently finding 30+% unique or new coverage in the patient access workflow. Improved staff engagement and satisfaction. Automation has greatly reduced manual inputs, enabling staff to focus more on the patient rather than systems and logins required for patient intake. Our partnership with Experian Health helps Banner Health's revenue cycle team deliver on its mission of “getting it right, at the right time, every time."  — Becky Peters, Executive Director of Patient Access Services, Banner Health  

Despite the majority of elective procedures being up and running again, patients are still keeping their distance. Nearly half of Americans say they or a family member have delayed care since the beginning of the pandemic, while visits to the emergency room and calls to 911 have dropped significantly. Patients are avoiding care, but it’s not for the reason you’d expect. Beyond obvious worries about catching and spreading the virus, a second concern is becoming apparent: patients are fearful of the potential cost of medical care. With so many furloughed, laid off or losing their insurance coverage, medical care has become unaffordable for millions of Americans. It’s especially tough for those who fall into the coverage gap, where their income is too high to grant access to Medicaid coverage, but too low to be caught by the ACA safety net. If patients continue to delay care, it’s only a matter of time before their symptoms worsen, leading to more complex and expensive treatment or even risking their lives. For the hospitals and health systems with revenue levels at a record low, encouraging patients to return for routine care is a matter for their own financial survival too. The answer lies in making sure patients feel safe and comfortable both when they come in for care, and when they look at their financial responsibilities. 5 ways to ease the return to routine care 1. Reassure patients about safety measures before and during their visit Patients are understandably anxious about what their visit is going to be like. Will they have their temperature taken? What should they do if they have symptoms of the virus? Will seating areas be spaced out and sanitized? Pre-visit communications and proactive information on arrival will help them feel comfortable and eliminate the shock factor of seeing more stringent infection control measures. 2. Minimize unnecessary contact by shifting patient intake online From online scheduling and pre-registration to telehealth and contactless payment, there are many ways to keep face-to-face interactions to a minimum. Not only will this help reduce the spread of the virus, it’ll make the whole patient experience more convenient for patients. Exploring a virtual and automated patient intake experience can also free up staff to work on other tasks, thus also protecting the organization’s bottom line through efficiency savings. 3. Encourage patients back to care with automated outreach campaigns With so much uncertainty at the moment, patients may be unsure if it’s even appropriate to come in for routine care. Use automated outreach to prompt them to book appointments and schedule follow up care. A digital scheduling platform can help you set up text-based outreach campaigns, to reassure patients that it’s safe (and essential!) to come in for any overdue care – without placing any undue burden on your call center. 4. Provide price transparency before and at the point of service With healthcare experts pointing to financial worries as a major barrier to care, anything providers can do to improve the patient financial experience is an advantage. Price transparency is the first step. When patients have clear and accessible payment estimates upfront, they can plan accordingly and/or seek financial assistance as quickly as possible, reducing the risk of non-payment. 5. Screen for charity care eligibility with faster automated checks Once those payment estimates have been generated, the next step is to confirm whether the patient is eligible for financial support, in the event that they’re unable to cover their bill. Checking eligibility for charity assistance is a time-suck for patient collections teams, but with access to the right datasets, it’s a perfect candidate for automation. These steps become even more urgent as providers face the prospect of a ‘twindemic’ – or a surge in COVID-19 cases colliding with flu season. By avoiding delays to care, patients can avoid the need for more serious and expensive treatment further down the line, when hospitals are likely to be under even greater pressures. Contact us to find out more about how our data-driven, automated patient intake solutions can help make your patients feel as safe and comfortable as possible, both physically and financially.

Can providers do anything to reduce the amount of care they give away for free, or has this become a cost of doing business? Declining Medicaid coverage, salary increases that aren’t keeping pace with rising deductibles and confusion over co-payments are creating a perfect storm for uncompensated care. Patients are responsible for a bigger chunk of their healthcare bills, while at the same time finding it harder to pay. As a result, unreimbursed costs are surging. In health system-owned hospitals, lost revenue jumped from $13.7 million to $15.6 million between 2015 and 2018, while independent hospitals saw losses rise from $4.9 million to $5.8 million in the same period. Not surprising, when more than half of consumers say they’d be unable to pay an unexpected bill of more than $1000. Reducing bad debt calls for more than a few set-and-forget tweaks to your revenue cycle management. From the moment a patient is admitted, you should be able to see exactly what coverage they have (or don’t have), so you can get them on the right track to devise payment plans, find missing coverage, or screen for financial assistance and charity eligibility. To save collections teams and patients from a painstaking manual process, more providers are turning to automated data analysis tools. Here are three ways automation can help reduce bad debt, protect your balance sheet and create a better patient experience at the same time: 1. Avoid missed coverage with better screening Why waste staff time on a treasure hunt for payments and coverage status? If your patient access team can obtain accurate financial data during the admissions process, they’ll be able to confirm active coverage quickly, or screen for Medicaid, charity or other financial assistance. This is increasingly important as the volume and complexity of your collections case mix develops. Brandon Burnett, Director of Patient Financial Services at Kaiser Permanente Northern California, says: “Coverage has gotten a lot more complex – patients show up in multiple venues of care and they don't have their insurance card, or they don't know what coverage they have… It’s critical that our team has tools they can use to help drive decisions and navigate those patients into the appropriate program.” Automation allows this to happen more reliably and more efficiently. Burnett says: “At Kaiser, we’ve implemented the financial assistance screening tools and the patient identity screening tools to help us identify what our members would be able to pay at the point of service, and how we would manage them in the back end if they end up with a patient balance. Before we had these tools, we were really blind as to what our patients were going to be able to pay.” At Kootenai Health in Idaho, an automated financial clearance tool helped save 60 hours of staff time in eight weeks. With an overall accuracy of 88%, patients were assigned to the most appropriate financial pathway (such as customized payment plans or checking for financial assistance). This helped eliminate the need for unnecessary charity applications and avoiding write-offs – such as the $200,000 bill for one patient, later discovered to be eligible for Veterans’ benefits. 2. Provide more compassionate financial counselling According to Burnett, “The ultimate goal is to have a positive impact on our patients. Nobody wants to go to hospital. Nobody wants to have surgery. Having solutions which allow decisions both at the point of care and in the pre-service cycle are critical in enabling patients to make decisions.” When patients are kept in the loop and can be active participants in their healthcare journey, you can work with them to manage their financial obligations in a way that works for them. With data-driven software, you can evaluate their ability to pay so you can offer the most appropriate payment plan and ultimately see fewer amounts written off. Additionally, automated data analytics can help make the whole process more compassionate, allowing you to tailor the way you communicate with patients based on their preferences and offer more convenient ways for them to pay. 3. Reduce manual touchpoints for better use of staff time The volume of patients applying for charity support is trending up, so it’s important that providers are able to manage the rising numbers of complex cases. Automating the coverage checking and clearance process can help reduce pressure on staff, minimize errors and increase productivity. They’ll be able to focus their attention where it’s needed most, and you can cut your reliance on external vendors. The scale of the challenge means providers need to think about a completely different way of working. It’s not enough to paper over existing processes. As Burnett says: “You can't take a solution and put it over an old process. Part of the enhancements with this technology is being able to evaluate your current workflows. That's where the real power is – in the cost savings and the time savings. If you take an updated process along with the updated technology, that's when you get maximum results.” Automated tools can help by giving you the necessary data insights to improve your workflows and processes, while integrating cutting-edge technology for more efficient and accurate patient screening. Find out more about how Coverage Discovery and Patient Financial Clearance could help your organization reduce bad debt and offer a more compassionate patient financial experience.

In the span of a single week in March, more than three million Americans found themselves unemployed as a result of the coronavirus pandemic. With health insurance so often tied to employment, the spike in the number of people now without coverage is going to leave many both clinically and financially vulnerable. Even those who still have insurance may be unsure about what it actually covers – and whether they can afford their co-pays. Despite being busier than ever, hospitals are seeing revenue drop due to the cancellation of many services that generate revenue, in order to accommodate the existing or expected surge in COVID-19 patients. That revenue loss may be even more at risk going forward as patients struggle to pay. With many hospitals already operating at slim margins, the consequences of a rise in uncompensated care could be significant. Finding strategies to quickly and accurately identify coverage for patients amidst the chaos is critical. Providers need a collections process that’s compassionate towards stressed out patients, and efficient for staff to manage mounting caseloads in an increasingly complex collections landscape. How automation can help providers get COVID-19 covered Automating the coverage discovery process can help solve for many of the current challenges. Here are five use cases: Speeding up coverage checks for a changing case mix. With elective procedures cancelled, more hospital admissions are emergencies, where upfront coverage information may be missing. Add in changes to billing codes for added, changed and waived COVID-19 testing fees, and the collections process becomes a lot more time-consuming. Experian Health’s reliable, automated Coverage Discovery tool can help verify a patient’s insurance status quickly, and ensure the right bills are sent to the right place. Minimizing face-to-face contact during admissions. Social distancing means the admissions process is almost unrecognizable. Having software run coverage checks as soon as patients arrive will minimize the need for lengthy in-person conversations and help intake teams process patients much faster. Finding missing coverage, even when the rules are constantly changing. With many patients changing plans or switching to Medicaid or Medicare, it’s not always clear who should pay for what. Checking for government coverage and forgotten commercial insurance can eliminate expensive write-offs down the line, but it does take time. Coverage Discovery can quickly comb through available coverage, to find reimbursement options and give patients peace of mind. Sweeping for coverage information on telehealth services. Video and telephone-based platforms are the go-to solution for routine care right now. But billing teams don’t always know if calls should be charged at the usual in-person rate or not. With automation, payer updates can be checked upfront for any new references to telehealth and virtual care, so providers know what to charge. Making life easier for staff.When so many of the staff who’d normally check payer websites are now sheltering in place, homeschooling their kids or even in quarantine themselves, it’s unrealistic to expect productivity to remain high. Automation can reduce the burden by running high volume coverage checks, so staff can focus their attention where it’s needed most. Automated coverage discovery is no longer a “nice to have” Automation was already an attractive prospect for healthcare executives looking to “do more with less” and optimize their revenue cycle for the new quality agenda. In the current crisis, getting the information needed to secure reimbursements is even more urgent. By working with Experian Health, providers can use proven tools to check for missed coverage and reduce the risk of misclassified accounts. Experian Health’s Coverage Discovery generates millions of dollars of found coverage for hospitals when it’s business as usual. This could be exponentially higher in the coming weeks and months, as hospitals look for smarter ways to secure reimbursements. Find out more about how your organization can find missing coverage and streamline the billing process during the COVID-19 crisis.

The number of uninsured American adults has been rising steadily since 2016, reaching a four-year high of 13.7% in the last quarter of 2018. The challenges have been well-documented: low levels of health insurance contribute to health inequality, poor population health, and worse outcomes for individuals as people hold off seeking care. For providers, a growing uninsured population usually leads to an uptick in uncompensated care and a hefty blow to their balance sheet. Affordability is the main driver of this trend (due to rising premiums and tighter household budgets), but a big part of the problem is simply confusion around who is entitled to what. People may have coverage they don’t know about or have forgotten. Media reports and reduced outreach for Obamacare have left many wondering whether support from public insurers is even still available: a Kaiser Family Foundation study in 2018 found that around a third of Americans believed or weren’t sure if the Affordable Care Act had already been repealed. No wonder fewer people are signing up. Finding missing coverage is a challenge for most providers, but with the right discovery strategy, it’s possible to drive down the number of accounts ending up in bad debt collections or written off as charity designations. Top-performing providers use a four-part strategy, encompassing the following: 1. Look beyond self-pay patients For most healthcare providers, the search for missing coverage usually focuses on self-pay patients. In fact, many Medicaid, Medicare and commercially insured patients also have unknown additional coverage. Unearthing this secondary and tertiary coverage can help ensure the full amount is paid. Jason Considine, Senior Vice President and GM of Patient Experience at Experian Health, says: “Finding missing secondary or tertiary coverage for patients with Medicaid or Medicare can help hospitals capture the full amounts they’re entitled to and reduce the risk of revenue loss. Hospitals can claim against any balances not covered by public payers, but only if they look for additional coverage.” This means hospitals shouldn’t focus solely on scrubbing self-pay accounts. By searching additional commercial coverage and combing through Medicare and Medicaid coverage, you might be surprised at the level of reimbursement available for amounts that would otherwise have been written off. 2. Perform coverage checks as soon as possible The sooner you check for coverage, the sooner you can verify the accuracy of the account – and the sooner you can get paid. Essentia Health in Minnesota implemented a coverage discovery strategy that ran comprehensive coverage checks throughout the whole patient process. Patient accounts were scanned before they received care, then again at the time of service. Finally, searches for active insurance were performed 30, 60 and 90 days after service. Kathryn Wrazidlo, Patient Access Director for Essentia Health, says: “We found 67% of coverage for patient accounts that were self-pay or uninsured at the time of pre-service, and 33% at the time of post-service. This has helped patients because we’re actually billing their insurance versus billing them for self-pay. It’s helping staff because they’re billing the insurance company much quicker. There’s less rework. We’re decreasing the amount of time the account is sitting in AR by billing much sooner in the process.” 3. Access the widest possible datasets The whole point of the coverage discovery process is to track down coverage your patient doesn’t know about. So why would you limit your search to what they can tell you? Equally, searching through payer databases within what are often very limited search parameters can be a painstaking process. A more logical approach is to use a search strategy that covers historical data, demographic information and multiple proprietary datasets to cross-check patient accounts for previously unknown coverage. A tool that offers weighted confidence scoring and discrepancy checks can further reduce the risk of false positives and errors. With this approach, Experian Health’s Coverage Discovery tool analyzed more than 16.6 million accounts and found 3.6 million coverages, resulting in $5.8 billion billable charges found in 2018 alone. 4. Digest the data with reliable reporting tools Of course, checking more accounts and accessing wider datasets means you’re going to have far more data to handle. Automated scrubbing tools, quick-look dashboards and reporting software can give you instant access to the information you need. Working with a reliable partner can help you sift the data for additional coverage, and also provide insights into ways to boost workflow efficiencies and make life easier for your team too. Wrazidlo says: “We use the power reporting that’s offered with the Experian product and we also do reporting internally. The reporting helps us know whether the product is working for us or not. We can see how much we are recovering… My staff really enjoy using it.” Find out more about how Coverage Discovery could help you find additional coverage more easily, so you can get paid sooner and in full.

Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.

Why is missing coverage so detrimental? When patients are unable to pay, providers see an increase in self-pay receivables - 97% of hospitals reported an increase in self-pay receivables compared with the prior fiscal year. When providers can’t collect, the result is uncompensated care $35.7 billion – The amount of uncompensated care hospitals provided in 2015 (AHA, Dec 2016, http://www.aha.org/content/15/uncompensatedcarefactsheet.pdf) Registration errors and frequently changing insurance coverage contribute to an increase in self-pay receivables and bad debt: 20% error rate: Wastes an estimated $15.5B in claims that are never corrected and re-processed. Find previously unidentified coverage to reduce bad debt Experian Health’s Coverage Discovery® solution provides an efficient and trusted means for healthcare providers to reduce misclassified self-pay accounts. Our advanced self-pay engine maximizes the actionable coverage found for our customers across government and commercial payers, previously missed due to frequently changing insurances, data entry mistakes or patient misrepresentation to avoid high deductible health plans. The benefits to you: Make coverage identification more efficient Reduce number of accounts sent to collections & charity Maximize insurance reimbursement revenue Identify primary, secondary, & tertiary coverage Automate the self-pay scrubbing process What are our clients are saying about Coverage Discovery: [Video] Murry Ford, Grady Health System: “Coverage Discovery has brought in quite a bit of revenue for us—revenue that we would not have identified otherwise.” [Video] Mike Simms, Cone Health: “Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments—more than a 300% ROI. It’s well worth every dollar spent.” Here’s why Coverage Discovery is different: Flexibility: Multiple delivery options easily fit Coverage Discovery into your revenue cycle Time matters: Find coverage on-demand Powered by Experian: Billions of data assets improve account specific intelligence and maximize found coverage Relevant: Confidence Scoring reduces data noise and removes potential false-positives to ensure staff time is focused on actionable accounts Uncover previously unidentified coverage with Coverage Discovery.