Tag: Data and Analytics

In an ideal healthcare world, third-party payers would always make payments accurately and on time. Unfortunately, human error is unavoidable, so missed payments and underpayments happen. Identifying and correcting these inaccurate payments often falls to healthcare providers, and without a strategy to make sure payers are complying with your contract terms, these errors are bound to cause stress and volatility to your revenue cycle. There are, of course, external causes of underpayment that a provider can't necessarily control, such as payers misinterpreting contract terms or incorrectly calculating a payment. Providers, however, can counteract this by limiting internal mistakes like incorrect billing or failure to provide appropriate documentation. Still, it’s easy to let incorrect or late payments slip through the cracks, especially without a robust contract management system. Experian Health's Contract Manager and Contract Analysis tools can help providers make sure they're reimbursed quickly and accurately. How Contract Manager and Contract Analysis eliminate payment problems Experian Health's Contract Manager for Hospitals and Health Systems verifies the amounts owed for all applicable claims, monitors payer compliance, and models the financial implications of proposed contracts. And because Contract Manager’s data processing and storage is completely remote, providers get 24/7 web-based access with no capital investments required and no added cost for software or data updates. Contract Manager helped Timothy Daye, director of managed care contracting and reimbursement at Duke Private Diagnostic Clinic, part of the Duke University School of Medicine, identify underpayments and discover ways to avoid them in the future. “In addition to identifying underpayments,” Daye said, “there’s tremendous value in identifying billing issues that may result in underpayments and also identifying process improvements that can be implemented to eliminate the underpayments in the first place.” Contract Manager alone can identify and prevent late payments and underpayments, but when providers pair it with its companion solution, Experian Health's Contract Analysis, they can find added data and negotiating power to set contract terms that optimize third-party reimbursement. Because you don’t have a crystal ball to predict how all of the hundreds of variables in third-party contracts will affect payment, you need a contingency plan. That's where Contract Analysis comes in. By spotting unfavorable contract terms and offering real-world “what if” scenarios, Contract Analysis tells you exactly how proposed contracts with payers might affect your revenue cycle. You’ll know before signing on the dotted line how each part of the contract will play out. The Contract Manager and Contract Analysis combination allows you to audit payer contract performance to ensure compliance and maximize revenue. You could, for example, use it to check the accuracy of a reimbursement by comparing the expected payment to the actual payment, or you could recover from underpayments by finding lost revenue with data-driven insight. Contract Manager and Contract Analysis can also help you identify unusual causes of underpayments. For instance, when Daye and his team were working on a recent anesthesia project, they had to correct a non-standard billing situation. “The payer was taking a reduction by billing the QS modifier, which is outside of the norm of standard billing protocol,” Daye says. “We changed that process through the appeal with the payer by showing documentation that the QS modifier was informational only and doesn't warrant a reduction in payment." Had Daye and his team not been able to identify this system issue, they’d still be scrambling to determine why the payment was lower than they were expecting. However, by using Contract Manager and Contract Analysis, Daye was able to pinpoint an outside-the-norm situation and correct the payment discrepancy as quickly as possible. What makes the combo unique The Contract Manager and Contract Analysis combination is essential for any healthcare provider wanting to ensure it receives payments that are accurate and on time. By using proprietary valuation logic, these tools will give you more precise insight into your contracts, giving you a solid foundation to protect against any payment problems. Experian Health reimbursement specialists even offer complete contract maintenance to make things easier. Whether it's a coding typo or a misinterpreted contract item, there will always be some factor that could cause a payment error. And while you can’t control some of these unforeseen hiccups, you can use Experian Health's Contract Manager and Contract Analysis solutions to correct them in the most reliable, efficient way possible.

Providers can improve the customer experience and bottom line with the power of data and analytics. Introduction In an increasingly competitive and consumer-driven healthcare marketplace, it’s no surprise that providers are working harder to acquire and retain customers. Higher out-of-pocket expenses combined with more choice and control in when and where consumers receive care are driving more retail-like shopping behavior. As a result, healthcare organizations are looking for ways to slow or stop customer churn, drive audience engagement, and redefine how they interact with their customers instead of seeing them through a clinical transactional lens. Providers understand that they must deliver a positive overall experience to maintain a favorable brand in the community and earn customer loyalty, key factors in maintaining their financial solvency. While there are many facets to consider in providing customers a great experience during their healthcare journey, there hasn’t been much attention paid to the intersection between the clinical and financial sides of this experience. According to findings from an Experian Health study among 1,000 consumers and select providers, the greatest pain points and opportunities for improvement around the complete customer healthcare journey center on the financial aspects, from shopping for health insurance to understanding medical bills. This means organizations that want to meet the new demands of consumerism in healthcare and improve the holistic customer experience must address the end-to-end revenue cycle. Typical consumer healthcare journey* *Consumers revealed 137 “jobs” or “needs” associated with their healthcare experience, with varied levels of importance, difficulty and satisfaction. Money matters give consumers high levels of discomfort Using a “jobs to be done” methodology, qualitative insights were gleaned as to the jobs, or microtasks and decisions, consumers associate with a healthcare journey. Despite the staggering number and complexity of different “jobs” consumers must undertake just to access the care they need, patients’ biggest dissatisfaction centers on the process of paying for their care. Of all the activities included in a consumer’s healthcare experience — from acquiring health insurance to making appointments with providers to receiving treatment — the top “pain points” relate to money matters. Specific issues for patients surveyed include: Understanding how much is owed for services and if the amount is a fair market price Making sure they have money available to pay for services Determining what financial support is available (e.g., a payment plan) Ensuring that what is owed to the provider is accurate Understanding the amount covered by their health insurance [click on image to enlarge]   Providers also feeling the sting from unpaid collections, lack of customer service   The most glaring opportunity for improvement in the patient experience comes early in the journey — price transparency. Patients are understandably confused about what their health insurance covers. They can’t always understand medical bills, and they have difficulty finding out how much their out-of-pocket charges will be and what payment options are available to them. Providers are also suffering — from unpaid collections, low customer satisfaction levels and an inability to address issues holistically. Here’s what providers had to say: We’re addressing the patient experience in one-off initiatives. Help us holistically improve the end-to-end patient journey. Providers said key impediments to progress include lack of clear and consistent prioritization, significant interoperability issues, and complicated organizational structures. They are frustrated by how hard it is to execute holistic changes efficiently. We need to measure our customer experience better. We want to standardize an approach that will drive progress and impactful change. Providers don’t have a clear path to move from customer experience as a concept to a measurable discipline. It’s a priority for them, but few are using a measurement system they feel is helping them understand and improve their patient experience. Patients are suffering, in part due to a lack of understanding of their charges. We want to set better expectations and make the charges and the value of our services easier to understand. Rising patient responsibility and the proliferation of high-deductible health plans drive the desire for full transparency in costs. Managing expectations at each step is crucial to providing the most accurate information to the patient. We’re not equipped to address customer acquisition and loyalty. Help us efficiently attract more consumers and keep them with us long-term. The focus has always been on healing people, with less attention to the business and marketing aspects of providing care. Providers need to focus efforts on acquisition and loyalty, but they’re generally understaffed and lack the skills to do so. There’s no doubt that healthcare organizations want to evolve and are thinking differently about how they deliver services and the value associated with those services. Ultimately, those that see driving customer engagement and redefining how they interact with their customers as a necessity, rather than a luxury, will succeed. Revenue cycle solutions for today’s consumerism environment    Where to start? Key areas that can be addressed in the healthcare financial journey include: Comprehensive data – One of the core components of a patient-centric revenue cycle begins with the ability to use reference data to address duplicate medical records, understand a patient’s propensity to pay and identify social determinants of health. Incorporating this type of outside data into the revenue cycle won’t just create better patient experiences from the moment patients begin interfacing with staff, it will also optimize revenue for health systems while enabling a revenue cycle that puts the patient at the center of care. Patient identification – As hospitals must now deal with hundreds of thousands of electronic patient records, spanning multiple systems and departments, the traditional technologies for managing patient information are no longer sufficient. Using sophisticated matching technology and outside data sources can improve patient identification and prevent duplicate or overlapping records that result in inappropriate care, redundant tests and medical errors — as well as improving data accuracy for clinical, administrative and quality improvement decision purposes. Insurance reconciliation – Organizations can use automated technology to monitor claims data, real-time eligibility and benefits information, payer contracts, and charge description master (CDM) information to ensure that payers are meeting their obligations fully and achieve accuracy and transparency in healthcare costs. Closing the gap in payer contracts and reimbursement allows organizations to focus on providing transparent cost estimates throughout every patient’s continuum of care and helps patients know their costs so they are better prepared to pay them. Price estimates – Providing accurate patient estimates is quickly becoming the norm for health organizations. But to ensure patient satisfaction rates are being met, health organizations need to empower patients with a frictionless financial experience. By incorporating credit data into the patient billing process, health organizations can enable a people-first product design to price transparency and collections that extends benefits to more people by understanding the unique financial needs of each patient. Self-service portals – One way to engage patients is with an online and mobile-optimized experience that’s proactive, smooth and compassionate to empower patients to set up payment plans, apply for financial assistance, estimate the cost of care and review insurance benefits. Conclusion   With so much to consider when addressing the evolving patient/customer journey, providers are well-served to start by improving their customers’ financial experience. As the link between customer satisfaction and a health organization’s revenue continues to grow, efforts to create a better financial experience are crucial. Using comprehensive data and analytics to power the revenue cycle and customer relationship management initiatives will allow health systems to encompass the end-to-end customer journey to ensure streamlined operations, measure and improve performance with payers, and provide accurate insights into each unique customer and their needs. The key to establishing this customer-centric mindset is embracing the power of data and analytics. From offering access to automated, personalized tools to providing price estimates to informing about charity aid options and offering payment plans — all these innovations help customers feel they can make better decisions about their care and how to pay for it. The result is more satisfied customers and an improved bottom line for providers.

In a new whitepaper, Technology and Data-Driven Decisions Driving Best Practices for Patient Collections, Experian Health analyzes the results of two recently fielded surveys aimed at learning how organizations approach the process of obtaining payment from patients. The paper reviews both an HFMA-led survey and an Experian Health-facilitated one, discussing the current state of patient collections, as well as emerging best practices to improve performance. While knowing that organizations are working with varying degrees of success to offer more patient-friendly financial interactions, using technology and data to inform and drive patient engagement, Experian Health wanted to understand the best practices that organizations are using to elevate performance in patient collections. Our findings were published in this HFMA whitepaper which discuss the findings from these two research projects and validate best practices and offer unique insight into the successes and shortfalls of the patient financial experience at health organizations.

For healthcare providers, revenue cycle management has become more important than ever. Due to increasing complexity in the payer mix and patients encountering more out-of-pocket costs, revenue cycle directors are also finding management an uphill battle. To maximize their reimbursement rates, today’s healthcare providers must take control of revenue cycles, and that requires optimizing three particular areas: estimates, claims, and collections. However, this task is much bigger than one person or department to enforce. For success, revenue cycle directors require an array of reliable, automated solutions that allow leveraging a wide range of data and comprehensive analytics with minimal employee input. At Experian Health, we offer a variety of solutions that help optimize healthcare systems' revenue cycle management by simplifying the three key areas mentioned above. Unlock vital revenue cycle management capabilities With patients taking more responsibility for their medical costs, modern revenue cycles are most successful when tailored to patients. This includes providing accurate cost estimates upfront, making sure claims are clean before submitting, and prioritizing debt collection efforts where they are most successful. 1. Patient Estimates: providing accurate estimates early In our consumer-centric environment, patients expect a greater level of insight into the costs of medical procedures, preferably before receiving treatment. No one likes to be surprised months after treatment with medical bills that far exceed what they expected. In addition, state laws now require hospitals to provide more accurate patient estimates. For consistently accurate cost estimates, a healthcare provider must have a dependable price-generation process. For example, the estimates should incorporate a patient’s specific insurance information for accuracy. They should also be compared to the patient’s propensity to pay so a payment plan can immediately be set up, much like how financial institutions treat automobile loans. Patient Estimates, Experian’s price transparency tool, auto-populates much of the necessary data so healthcare providers can deliver accurate patient estimates as early as possible. In turn, consistently accurate cost estimates raise healthcare providers' chances of collecting revenue upfront and help avoid unnecessary headaches during the claims and collections processes. 2. Claim Scrubber: submitting clean claims The conflicts caused by denied claims are expensive to fix. Interactions with payers cost medical groups thousands of dollars per physician each year. Many of those interactions result directly from denied claims, which often stem from inaccurate data. Claims data can be edited in Experian Health's Claim Scrubber, which reviews each claim line by line and makes edits based on the platform's data. Claim Scrubber combines the data with general, payer, and patient-specific information to guarantee each claim is properly coded every time. 3. Collections Optimization Manager: collecting debt strategically and efficiently If a healthcare provider wants to redesign its collection processes to center around patients, it should rely less on random outbound calls and focus more on insight regarding each patient’s propensity to pay. The burden of collecting on past-due balances is a demanding task. It also reduces a healthcare provider's chances of successfully collecting bad debt. One of the most important reasons — among many — to consistently provide accurate estimates and claims is to make collecting debt more successful and less time-consuming. Granted, a healthcare provider can't expect to collect every single outstanding fee. However, by concentrating on patients who are able to pay, a much greater percentage can be collected. Furthermore, Experian Health's Collections Optimization Manager helps complete revenue cycle management by using in-depth collected data to identify patients who are most likely to pay their hospital bills. In turn, staff members can utilize their time and resources more efficiently by contacting these specific patients first. Like most companies, healthcare providers are beginning to realize that patient engagement is a top priority. With this elevated engagement comes the need for consistent price transparency for medical care. Luckily, Experian’s automated engagement solutions can help your healthcare system provide the increased transparency it needs while also optimizing its revenue cycle management.

Reimbursement pressures and the real potential of changing regulations require that revenue cycle leaders leverage data and technology to be as efficient and nimble as possible to maximize net revenue, reduce denials, and lower operating costs. Shifting reimbursement models, complex benefit designs and limitations, increased patient responsibility, and growing regulatory pressures are driving near-constant change in the healthcare revenue cycle. Healthcare organizations that used to be paid by the encounter are adapting to emerging trends of also being selected, measured, and paid for how they perform and collaborate with other providers to improve outcomes. This value versus volume movement has forced hospitals, physicians, and other providers to focus on delivering high-quality, collaborative care at a lower cost while enhancing the patient experience, including efficiency and patient sensitivity in the revenue cycle. Experian Health’s Revenue Cycle Analytics provides visibility across the revenue cycle continuum, transforming operational and financial information into actionable insights. By tapping into Experian Health’s vast product workflow data and revenue cycle transactions, you can hone in to optimize specific workflows and compare your facility’s operations and processes against industry peers to make more informed business outcomes. Relevant data is presented for users based on responsibilities. With your internal data, we can Improve your workflows, operational performance, and financial results by leveraging your data across the revenue cycle, matching it, and analyzing the account across the various revenue cycle workflows and transactions Ensure accurate reimbursement by analyzing workflows and optimizing activities Create and monitor revenue cycle KPIs around pre-service, point-of-service, post service, denials, etc. to provide data points needed for process and financial optimization Provide comparative analysis and benchmarking that scores payer performance based on claim, rejections, denials, and exceptions Identify trends by drilling down to the staff, department, and service levels to uncover insightful details Maximize return on investment in Experian Health revenue cycle management products Enable the calculations of HFMA Map Keys and NAHAM Access keys for true peer-to-peer benchmarking With decades of Big Data experience, and as experts in gathering and securely managing huge quantities of data, Experian Health’s Revenue Cycle Analytics manages an unrivalled breadth and depth of data to help clients gain a deep understanding of people, businesses, places, economics, and health.  

There has been a lot of uncertainty with regards to what the future holds for healthcare in the U.S., but the reality is that the move away from transaction-based services where providers are paid by transaction or by interaction with their patients, into a world where some of those services will be paid as bundles, is a reality. At Experian Health, our perspective is that there isn’t going to be one single form of payment. There isn’t going to be only fee for transaction or only fee for value type payments.  There is going to be a variety.  And our solutions can help providers handle that. When we talk to our largest providers, they want to make sure that they are prepared for the future of healthcare, and that their payment and revenue cycle is robust enough that they can handle whether it is a fee for transaction interaction with the provider or with the patient as well as fee for value. In order to do that, they have to optimize their operations. There is a lot of belt tightening happening in the industry and people are trying to see and understand how best to organize, how best to analyze and facilitate that payment cycle. We believe that data and analytics are two of the key ways to do that. Our software tools as well as the data that we embed into that software helps optimize the revenue cycle. Listen to the complete podcast

There’s a knock on the door, and it’s “big data.” The promise of Big Data is redefining patient care, becoming the norm in clinical settings as it drives clinical pathways and care decisions. But it’s now time to broaden healthcare’s perception of Big Data to show how healthcare organizations can open the door to other possibilities where it can have a dramatic impact on financial performance. The key opportunity centers on making sedentary data within your organization’s four walls actionable, especially when combined with other valuable data such as credit information, to improve financial performance, patient safety and patient satisfaction. Although there are many benefits to leveraging data in this way, there are three that rise to the top. Who knew the revenue cycle and patient access would be a first line of defense for patient care? A significant, yet often underappreciated benefit of a data-driven revenue cycle is improved patient safety. Identity theft and fraud are decreased by properly identifying the patient at the outset of the healthcare experience. This proactive approach can also ensure healthcare organizations treat the correct patient and avoid the risks associated with misidentification. It’s all about upfront payment whenever possible. The back end of the revenue cycle is shifting to the front — while nothing new, it’s an increasing reality dependent on important data points. Verifying benefits, eligibility and propensity to pay before the patient arrives or in real time at registration not only improves patient-provider interactions, it also allows the registrar, and other patient access professionals, to better understand the patient’s unique financial situation and engage in appropriate and tailored financial counseling discussions. While some processes remain on the back end, it’s really about having a clear understanding of the patient’s financial picture upfront. Collecting with compassion, and for the bottom line. Finally, collections become less about randomly tracking down payments and more about compassionate customer service and targeted process improvement by scoring and segmenting patient accounts. Data and analytics improve collections efficiency and profitability by streamlining processes and proactively assessing and responding to each patient’s unique situation, whether providing a customized payment plan or identifying charity care for a patient in need. And, robust data points on collections agency performance provide insight into which agencies are delivering the most return on which accounts, as well as where agency consolidation or internal support will yield stronger collections results. Big data has transformed clinical care. Now, it’s time to apply the same data-driven approach to mitigate financial risk and enhance the bottom line. Isn’t it time to answer that knock on your revenue cycle door?