Tag: patient estimates

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.

Manually cold-calling patients to remind them of upcoming appointments or of bills nearing a due date has never been an effective engagement strategy. On the contrary, such reactive tactics reduce engagement quality and can harm revenue cycles. It's important to remember that real connection empowers patients to be proactive in their care and improve their own outcomes, which encourages them to keep up with future appointments and medical payments. For modern healthcare organizations, maintaining this level of high engagement requires more than the automatic actions they’ve grown used to. Instead, the overall healthcare world needs more robust patient engagement to push forward and stay relevant with patients. Without this change, organizations are more likely to encounter skipped appointments, preventable readmissions, missed payments, revenue loss on several fronts, and poor patient outcomes. Fortunately, Experian Health offers a range of solutions that make it easy to engage patients in their care, improve patient outcomes, and create more profitable revenue cycle management (RCM) throughout an entire organization. Using patient engagement technology to improve care As previously mentioned in an Experian Health blog, patient portal technology — among others — is rewiring the technological landscape and capabilities in the physician and patient relationship. Portals are used for secure messaging by 41 percent of family practice physicians, and 35 percent of physicians also use them for patient education. This type of patient engagement technology culminates in our Patient Self-Service portal, which pools together data from our Patient Estimates, Patient Statements, and Coverage Discovery tools. The portal gives patients a single point of access to request estimates, pay bills, check financial assistance eligibility, and receive advice from doctors, nurses, and specialists. The above are just a few results from elevated, proactive patient engagement. Another perk is the portal’s unique ability to automatically populate patient-specific and payer-specific information into each estimate for optimal accuracy. This feature gives patients peace of mind by knowing what their exact out-of-pocket expenses amount to. When they receive a bill that matches the estimates they’ve been budgeting for, patients are more likely to adhere to payment obligations and return to a healthcare organization for future medical needs. This also makes it easier for an organization to collect payment at point of service and throughout the rest of the patient’s care continuum. Risk stratification for more successful revenue recovery For the first time in history, there is a growing convergence of powerful, internet-connected personal devices and massive amounts of analytical, social, financial, and behavioral data tied to individual patients. Experian Health’s timely patient engagement tools allow providers to tap into this convergence to revolutionize how they engage with patients at all points throughout their care. For example, by analyzing patient-specific financial information, this engagement technology can help providers identify when patients may benefit from financial assistance, especially for upcoming treatments. In turn, the provider can send the patient information about how to request for this type of assistance through an interactive portal with accurate estimates. To help reduce readmission rates for non-critical concerns, Experian Health’s tools can also help identify when patients may need unique, targeted engagement. For instance, patients with heart conditions can benefit from information regarding diet and lifestyle changes that improve cardiovascular health. These tools help providers determine the best type of content to send and the appropriate medium to send it through, such as email, text, or app notifications, according to the patient’s specific preferences. By working together with healthcare providers, Experian Health’s solutions combine highly personalized self-service with accurate price transparency and patient-risk stratification to proactively engage with patients. You, too, can be at the forefront of improving patient outcomes and RCM strategy effectiveness by understanding the changing healthcare environment. Utilizing tools, such as a patient portal and others, can position your organization to increase patient engagement and benefit from being a forward-facing healthcare provider.

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.

With the ability to research products, compare price information, and conduct transactions all from their mobile devices, today's consumers are more savvy than ever. They expect an unprecedented level of transparency from companies. In fact, they demand it and will easily take their money elsewhere if a company doesn't follow through. Consumers expect the same high-level transparency from healthcare providers, and the demand is growing as patients are forced to bear more out-of-pocket costs for medical care. They want to avoid surprises, such as higher-than-expected cost estimates for services or insurance that may cover only a small portion of the expense. Price transparency initiatives are becoming increasingly more important in healthcare systems, and providers must embrace new capabilities to meet patients' expectations. The old model of billing patients weeks or months after they’ve received services is no longer viable. Billing needs to move to the front of the revenue cycle management process, and a number of Experian Health's solutions are designed to help do just that. 3 tools for greater price transparency in healthcare As patients are responsible for a higher percentage of their healthcare costs, healthcare providers' financial performance depends on an optimal collections strategy that focuses on patient engagement. The advantage of patients knowing and having confidence in healthcare cost estimates makes the collections process much easier and helps drive the future revenue cycle. Here are three Experian Health solutions that can help healthcare providers improve price transparency: 1. Patient Estimates: Patient trust is built on meeting expectations. With this in mind, Experian Health's Patient Estimates tool brings accurate, upfront price transparency before or at the point of service so patients know what to expect and can confidently make decisions about their healthcare. Cost estimates are derived from numerous types of data, including a patient’s benefits information, a healthcare provider's reimbursement agreements, and payer contract rates, among others. Much of the information can be automatically populated into the system, eliminating the need to constantly update price information lists and reducing the risks of inaccurate cost estimates resulting from error. With Patient Estimates, healthcare providers can also more effectively comply with state and federal price transparency requirements. 2. Patient Statements:Accurate price information is one thing, but even if the patient’s billing statement matches the cost estimates, collections can be a challenge if the statement is hard to read or understand. Patient Statements is a communications tool that simplifies and customizes patient billing statements, complete with important, easy-to-understand updates and messages. Making billing statements straightforward for patients to manage helps healthcare providers build a stronger level of trust when it comes to payments. Personalizing the statements with marketing and educational information turns them into valuable resources that create a better overall patient engagement experience. 3. Patient Self-Service:With accurate, upfront price estimates and simple, useful bill-paying systems and statements, healthcare providers can more successfully integrate our online self-service portal. Experian Health's Patient Self-Service tool digitally delivers cost estimates and statements to patients. It also allows patients to securely make payments and conveniently schedule future appointments from their desktop or mobile devices. Patient Self-Service brings the high level of price transparency to healthcare providers that consumers now expect. This makes it more likely for patients to meet their self-pay responsibilities and return for future healthcare services. Patient Self-Service also helps healthcare providers more efficiently comply with "meaningful use" Stage 2 program requirements. The capabilities for price transparency that these solutions provide is just a small sampling of what we offer today, and we’re continuing to research and develop even more useful tools. In addition, we’ve recently launched an extensive consumer research project to better understand patients’ wants and needs. We’re excited to use these insights to continue developing solutions that help healthcare providers improve engagement with patients.

Undoubtedly, you have been monitoring progress toward legislation for healthcare providers to furnish patients with estimates for their cost of care. And if it’s not already in place, there’s a strong chance your state will be next on the list to require price transparency. Additionally, with the continued popularity of high deductible health plans, patients are looking to price shop for their healthcare services. Patients expect more healthcare cost information available online, like in every other industry. Helping patients know what they will owe prior to service can enable them to make more informed decisions about their care and increase patient satisfaction. As more states begin to mandate providing pre-service estimates to patients, it’s critical for healthcare providers to know what solutions are available to help them comply. According to a recent Fierce Healthcare article, “Real healthcare price transparency for consumers is dependent on rich data sources that provide meaningful price information on a wide range of procedures and services.1" Experian Health is here to help! Our Patient Estimates solution is a pricing transparency tool that enables you to create accurate estimates of services, before or at the point-of-service. Patient Estimates is also offered within our Patient Self-Service portal, allowing patients to access estimates on-demand. See how Patient Estimates helped St. Clair Hospital in the Pittsburgh market. According to the June 2016 KLAS Healthcare Price Transparency Solutions Performance Report, “…clients feel [Experian Health’s] Patient Estimates is a critical element in their efforts to help patients know up front what their costs will be, and clients report overall satisfaction with the product, services, and vendor engagement. The solution is seen as very complete and robust, with strong customer support.” Experian Health's Patient Estimates can help your organization: Increase up-front collections Provide patient’s pricing prior to service Increase patient satisfaction Let us help you prepare now for state requirements that will ultimately increase accurate up-front collections and more importantly improve patient satisfaction! Call us at 1 888 661 5657 or email experianhealth@experian.com to get started!     1Ron Shinkman, “A few more states get passing grades on price transparency,” Fierce Healthcare, July 28, 2016

Experian Health is pleased to announce that its Patient Estimates solution has joined the athenahealth® Marketplace, also known as  the More Disruption Please (MDP) program. Experian Health has participated in this program since the launch of the marketplace in 2013 (starting with our Contract Management offerings) and has worked with athenahealth to integrate its industry-leading capabilities into the organization’s growing network of more than 73,000 healthcare providers. Learn more about Experian Health’s Patient Estimates solution. Read the press release To learn more about athenahealth’s MDP program and partnership opportunities, please visit https://www.athenahealth.com/disruption.

Experian Health is pleased to announce that we went live with Patient Estimates at St. Clair Hospital located in Pittsburgh, PA on February 22, 2016. A true representation of vendor and hospital collaboration and commitment, the Patient Estimates cost transparency tool gives St. Clair a competitive edge as the first hospital in its region to offer patients cost estimates in advance. Patient Estimates is not a list of charges, but an interactive and user-friendly tool that provides information that is highly specific to the individual. Estimates are designed to determine, in advance, each patient’s out-of-pocket costs (deductibles, co-pays and co-insurance) for services at St. Clair based upon his/her insurance coverage. The estimates also incorporate St. Clair’s discounts for payment on the date of service and for those without insurance. The estimates remain in the system and can be recalled for future reference. Patient Estimates is simple to use and is conveniently available 24/7 at www.stclair.org. On the home page, patients will select the “Financial Tools” option, then click on Patient Estimates. They will then enter their health insurance information before choosing one of the 100 listed clinical services (e.g., a procedure, treatment or diagnostic test) from the drop-down menu. The tool then provides a customized estimate of their out-of-pocket expenses. Patient Estimates is designed to help insured and uninsured patients get clear, real-time, easy-to-understand cost estimates for St. Clair’s services so patients can make informed decisions about their care. Below are some of the press mentions of St. Clair Hospital's implementation of Patient Estimates: Pittsburgh TRIBLIVE https://bit.ly/1oxlKna Pittsburgh Post-Gazette: https://bit.ly/219dqfd Pittsburgh Business Times: https://bit.ly/1QWfqNa

There’s a unique dichotomy in healthcare that’s not found in other service industries. For example, when you go out to eat at a restaurant, you don’t expect the server to ask you to pay before the meal is served. Conversely, you also don’t expect to walk out of the restaurant after the meal without paying. However, if you have ever ordered the special of the day and been shocked when the check arrives and the item costs twice as much as other menu items, you can certainly understand the patient’s viewpoint. How can a patient make informed choices about his or her healthcare without knowing the cost? Price transparency – one of today’s hottest healthcare topics – offers significant benefits to both providers and patients, including: Empowering the patient to make well-informed decisions on healthcare treatments Improving patient satisfaction and involvement with their care management Allowing appropriate upfront collections based on realistic estimates Serving as a foundation for establishing payment plans or seeking charity The difficulty of providing a reliable estimate has hindered efforts to collect from patients at the point of service, when they are most likely to pay. In order for the estimate to be relevant and timely, it must bring together financial data from the chargemaster, claims history and payer contract terms, and integrate that with the patient’s insurance benefits. Thankfully, this is a task that is ideally suited to technology. Not only can you use a payment estimator to quickly and easily create a targeted estimate, healthcare organizations can also eliminate the need to manually update price lists, as well as remove guesswork and tedious searches through potentially outdated patient information. An estimator is the base of an effective upfront collections strategy, and is complemented by the ability to determine if a patient is eligible for charity care in addition to their propensity to pay. An additional complement is to streamline the payment process by facilitating the collection of patient open balances through eChecking, signature debit, credit, recurring billing, cash, check or money orders. The ability to create price transparency that is applicable to each patient’s individual situation is critical to a healthcare organization’s financial performance.