Tag: patient financial clearance
The Health Resources and Services Administration (HRSA) recently ended its COVID-19 Uninsured Program (UIP), meaning that providers can no longer seek reimbursement for COVID-19 testing, treatment and vaccine administration for uninsured patients. Evidence suggests that there could be new infections in the fall and winter, which means the need for testing and treatment has amplified. A $10 billion COVID-19 funding proposal that followed this program is also being held up in Congress, which means that it can take much longer before funding is provided. While this bill may eventually be approved, it is unlikely to include uninsured Americans. This means healthcare organizations must be extra vigilant to find missing insurance coverage for COVID-19 care. The challenge is broader than the end of the UIP program. Continuous Medicaid enrollment will also come to an end when the pandemic is no longer considered a public health emergency. Providers will need to resume eligibility and renewal checks, which will cause massive disruption as millions of individuals potentially lose coverage. In the face of reduced reimbursements, providers may have no choice but to turn away uninsured patients or absorb care costs themselves. But there is a third option – to check for missing and undisclosed coverage and maximize opportunities for reimbursement throughout the patient journey. This can be resource-intensive if not implemented strategically. It often requires a major investment of staff time and effort, which many organizations can hardly afford, as a result of staffing shortages and larger financial pressures. However, with the right data, automation and coverage discovery strategies, providers can maximize available reimbursements and minimize disruption, without eating up staff resources. Here are 4 strategies to find missing insurance coverage and increase reimbursement as COVID-19 funding ends: 1. Run continuous checks for missing coverage As churn increases gaps in coverage, providers must perform due diligence to find coverage for their patients. Many patients have forgotten or undisclosed coverage; however, tracking it down can be an administrative nightmare. It requires staff to run multiple checks of public programs and disparate payer networks, with no guarantee that coverage will be found. With such huge changes to the Medicaid landscape on the horizon, manual checks are not an option. Providers must find an efficient way to check coverage for patients who need COVID-19 testing and treatment, or for those who may be losing government coverage. Experian Health's Coverage Discovery uses advanced data analytics and automation to help providers locate hard-to-find coverage, without placing an undue burden on staff who are already under immense pressure. Coverage Discovery uses millions of data points and sophisticated confidence scoring to comb through government and commercial payer databases, eliminate write-offs and speed up reimbursement. It automatically runs checks before the patient comes in for care, at the point of care, and post-service. This ensures that if the patient's coverage status changes during their healthcare journey, potential reimbursement opportunities won't slip through the cracks. This solution helped identify previously unknown billable insurance coverage in more than 27.5% of self-pay accounts in 2021. 2. Verify coverage as early as possible Federal funding during the pandemic required states to expand Medicaid support, leading to an unprecedented 85 million enrollees. As emergency support winds down, state Medicaid agencies will have one year to check the eligibility of each individual and notify those who no longer qualify. With each check taking around two to three months to complete, agencies and providers will need robust workflows to maximize capacity and communicate with patients. A KFF survey in March 2022 found that only 27 out of 50 states had plans in place to address eligibility redeterminations and disenrollments once continuous enrollment ends. Access to reliable datasets and automated software can help providers confirm patient contact details and continue checking for coverage as patients transition from one plan to another. Should coverage be found, providers then need to verify that planned treatment or services are eligible for reimbursement and determine the patient’s financial responsibility. The sooner this can be done, the more likely it is that bills will be settled. Experian Health's Insurance Eligibility Verification solution can be part of the strategy to streamline eligibility checks and verify active coverage earlier in the billing process. This continuous, automated workflow uses real-time data to drive higher reimbursement rates so that providers can focus on providing the best care for their patients. 3. Get patients onto the right plan to increase rapid reimbursement In many cases, government and commercial coverage only cover a portion of a patient's medical bill. If more patients are responsible for a greater portion of costs – whether for COVID-19-related care or otherwise – there's a higher risk of delayed payments. Confusion over federal funding or changing Medicaid coverage could compound this. Providers can improve recovery rates by assessing a patient's ability to pay early in the process, and quickly steer them toward the right financial pathway. Patient Financial Clearance determines which patients are more likely to pay and connects others to payment plans and financial assistance programs, so collections teams know where to direct their resources. Not only does this improve workforce efficiency and avoid missed reimbursement opportunities, but it also means that fewer patients will have to miss out on necessary care because of ambiguity over how it will be funded. 4. Optimize collections to direct resources to the right accounts Another way for providers to protect their revenue once federal reimbursements end is to optimize the collections process. Collections Optimization Manager helps providers adopt a targeted collections strategy, to focus on accounts with the highest likelihood of being paid. Novant Health used Collections Optimization Manager to automate patient collections for a faster, more efficient and more compassionate collections experience. This collections technology allowed the team to tighten up patient segmentation, allocate staff resources more efficiently and keep a closer eye on agency performance, leading to a 6.5% recovery rate and a 5.8% increase in unit yield year-over-year. Learn more about how Experian Health's Coverage Discovery solution can help providers find missing insurance coverage and secure higher reimbursement rates as pandemic support programs come to an end.
No healthcare organization is immune to the problem of bad data. One in five patients has found errors when looking at their electronic health record (EHR). This includes incorrect information about their diagnosis, medications, test results and more. If the data held in patient records is incomplete, inconsistent, or inaccurate, this can lead to poor clinical decision-making, substandard patient experiences, and gaps in treatment or follow-up. In Experian Health’s State of Patient Access 2.0 survey, patient identity management emerged as a major challenge for healthcare providers, with almost half of the respondents saying that inaccurate and incomplete patient data hindered follow-up contacts and patient outreach. “Dirty” data also presents a major financial risk, costing healthcare organizations millions of dollars per year. Many providers have stepped up their digital offerings in the last few years, particularly in response to the pandemic. While digitalization offers huge advantages, it does have an unfortunate side effect. As more data is created, shared and accessed, there are more opportunities for mistakes. Some industries may accept a certain amount of rogue data as inevitable, but in healthcare, it mustn’t become the norm. Patient data needs to be consistent, complete and standardized to ensure the highest standards of care. The Centers for Medicare and Medicaid Services (CMS) recognizes the need for an easier and more secure exchange of healthcare data, and are taking steps to facilitate interoperability. As these provisions are finalized, providers can act now to embed data standardization in their digital services. Better data means better decisions, better care and lower costs. As the digital transformation continues, providers must implement strategies to eliminate inaccuracies, enable consistent identity management, and ensure data is standardized across all their systems and networks. In this article, we share three steps to help your organization ensure that patient data remains complete and consistent for better patient identity management. 1. Start with the right patient data As the saying goes: garbage in, garbage out. Reliable patient records require the right information to be added from the start, or errors will follow the patient throughout their healthcare journey. This will only continue compounding over time. A 2021 survey of Experian Health clients revealed that incomplete data arises for a variety of reasons. This ranges from patients not filling out forms correctly prior to their visit or forgetting their insurance cards, to staff having limited time to complete documentation. Typos, misspellings, duplicate data and missing information can also cause identity errors.* Providers should reduce the risk of inaccurate data from being added to a patient’s record in the first place. A standardized approach to data formatting is a good place to start. For example, if a patient is accustomed to writing their date of birth in a European format, with the day before the month, they may enter this incorrectly when filling out online patient access forms. Configuring calendar drop-down menus in such a way that prevents this will avoid these basic but costly errors. With a Universal Identity Manager (UIM), each patient’s record can be maintained in a standardized format. Probabilistic and referential matching techniques are used to check the patient’s identification information against existing databases, for a more complete view of the patient regardless of any data gaps. 2. Solve patient matching challenges with robust identity verification It doesn’t matter if patient records are accurate if staff pull up the wrong record when they speak to a patient. Providers should prioritize consistent identity management to ensure clinical and non-clinical staff see the same and correct information, regardless of where or when a patient interacts with their organization. Identity Verification validates the patient’s identification information during pre-registration and check-in by instantly accessing demographic information. This includes the patient’s name, address, Social Security number, date of birth, phone number and insurance coverage data. If there’s a mistake, it’s easily found and corrected. 3. Standardize data to maintain clean patient databases Victoria Dames, Vice President Identity Management at Experian Health explains why standardization is so important: “The increasing use of digital services means that more healthcare data is being exchanged within and between health systems than ever before. However, in order to leverage the opportunities that come with a more connected healthcare system, we need that data to be as reliable as possible. Preventing inaccuracies before they occur will be much more cost-effective than scrambling to fix them after the damage is done. With a standardized approach to data collection and management, healthcare organizations can maintain reliable records for every individual patient and stay ahead of the game as more data is generated and shared.” Unique Patient Identifier (UPI) helps providers eliminate duplicate records so there’s a “single source of truth” for each patient. After the UIM matches the patient’s information within a single and accurate patient file, a UPI is assigned to that record and maintained in a master index. This is far more secure than a traditional matching algorithm based on Social Security numbers, which can be vulnerable to errors. Together, these tools help healthcare providers create and maintain a “golden record” for each patient. Data quality will always be a challenge. However, with the right data standardization strategies, providers can make better decisions. This will create better patient experiences and better health outcomes while limiting the financial impact of dirty data. Contact Experian Health today to find opportunities to clean up your healthcare data for better patient identity management. *Survey of Experian Health clients, October 2021 Are you an Experian Health client? Then we invite you to join our Innovation Studio research community. Your ongoing input is key to driving improvements to our tools and products! Sign up here!
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
As 2020 draws to a close and headlines hint that the end might finally be in sight for the pandemic, the healthcare industry is considering COVID-19’s legacy. The sudden shift to contactless care, financial consequences of widespread social distancing measures and changing expectations of the patient experience have upended the world of healthcare and health IT – but which changes are here to stay? And what do these changes mean for the patient experience in 2021? We asked several leaders across Experian Health for their predictions in the areas of patient access, collections, and identity management, and here is a preview of what they had to say: “Patients will choose providers that give them control over their healthcare experience” Patients have more opportunity today than ever before to manage their healthcare experience from the comfort of their own home, whether that be through patient portals, online self-scheduling and registration or online payment tools. As lockdowns and social distancing prevented patients from presenting in person, providers were forced to offer patients with more options for self-service. Unsurprisingly, this was a move a lot of patients have been waiting for and many welcomed this new technology with open arms. Jason Kressel, senior vice president of consumer products and analytics at Experian Health, expects that, as patients become more accustomed to this level of self-service, more than half of consumers will change providers in favor of one that offers premium digital healthcare services: “Providers who can meet patients where they are—through web-based services and via their mobile devices—will have the most success with retaining and attracting patients.” Online self-scheduling can put patients in the driver seat while also avoiding unnecessary contact while many remain cautious about on-site visits. With access issues removed, the patient experience will improve, in turn improving health outcomes (and providers’ bottom lines!). “With hospital finances on shaky ground, collections will be a top priority for survival” As COVID-related unemployment leads to an unstable insurance landscape, many providers are worried about maintaining effective collections processes, and they cannot afford to spend time chasing payments. Guarding against uncompensated care and tightening up the collections process will be essential. Automated collections software can help collections teams focus their efforts on patients who are most likely to pay, while also helping patients manage their financial obligations with as little stress as possible. Providers can also quickly determine which patients qualify for financial assistance, helping them get them on the right payment pathway for their circumstance without delay. Not only will this provide a much better patient financial experience, it’ll prevent “lost coverage” and allow providers to collect a larger portion of dollars owed. “The surge in portal usage means providers need to watch out for fraudsters” What does the rapid growth in portal uptake mean for data security? The speedy rollout of telehealth and other digital services has exposed security concerns for many providers, who fear a rise in fraudulent activity in 2021 as cybercriminals sniff out opportunities to steal patient data. To protect patient information and avoid costly reputational damage, providers must adopt more sophisticated identity management solutions. By combining cutting edge identity proofing, risk-based authentication and knowledge-based questions, providers can more easily verify a patient’s identity when they log on to their portal, greatly eliminating the risk of fraud. Interested in learning more about other trends that could affect the patient experience moving forward?
There’s a phenomenon in online product reviews where the customer seems to love their purchase, yet gives it only one or two stars. Why do they do this? Poor customer service: the item was delivered late, questions went unanswered, or payment processing was disorganized. When the consumer experience falls below expectations, the brand suffers – no matter how good the product. The same thing happens in healthcare. The clinical care may be outstanding, but if the patient finds billing frustrating or confusing, it’s those feelings they’ll associate with the overall experience. Many healthcare providers suffer reputational damage because the patient financial experience fails to match high quality clinical care. This is especially true for patients who find themselves without coverage and in need of financial assistance, which is often an extremely stressful process. And with unemployment levels soaring as a result of the coronavirus pandemic, it’s likely more Americans will need to explore eligibility for charitable support. Finding smarter, speedier and scalable ways to check charity care eligibility is even more important. Using automation for faster charity care checks Automation may be the answer. With a system that runs checks quickly and easily against vast databases of up-to-the-minute records, providers can discover a patient’s propensity to pay before treatment is even carried out. Clarity from the outset ensures the patient is put on the right payment pathway and lays the groundwork for a positive patient financial experience. Caye Mauney, Patient Access Director for Palo Pinto General Hospital, tells us how her organization used data-driven financial clearance checks to improve the patient financial experience and reduce bad debt: Speeding up checks for earlier eligibility decisions Prior to using automation, Palo Pinto General used a time-consuming and labor-intensive paper-based process to determine a patient’s eligibility for charity assistance. But with automated screening prior to or at the point of service, the hospital can now verify whether patients qualify for charitable assistance within three seconds, and quickly connect them to the right program. For those with a self-pay amount, a Healthcare Financial Risk Score can be calculated using historical payments information and credit history, to help determine the optimal payment plan. Mauney says: “All the information we need is now at our fingertips. The patient no longer needs to bring in check stubs or go back to a former employer to ask for information. It’s been a game changer.” Creating a personalized patient experience At Palo Pinto, staff wanted to make sure that patients were taken care of not only medically, but financially too. Just as each patient needs medical care tailored to their individual needs, so too should their financial accounts be handled on a case by case basis. With custom payment plans based on an individual’s unique financial situation, the payment process can be transformed into an experience that patients no longer dread or avoid. Automated patient clearance checks draw on multiple sources of data and run analytics to quickly determine the best option for each patient. It can also generate scripts for patient advocates to use, to help patients navigate the process more easily. Palo Pinto reports improvements in patient satisfaction and trust as a result of uncomplicating the patient experience in this way. Reducing bad debt and increasing point-of-service collections Seamlessly connecting patients to the right financial assistance program allows patients to focus on their treatment, while feeling reassured that their financial obligations will be met. For providers, swift processing means decisions are made quickly, resulting in fewer accounts receivable delays and a lower risk of uncompensated care. At Palo Pinto General, quicker charity applications means more are being approved, and therefore not written off as bad debt – ultimately helping their bottom line. Discover how automating checks for charity care eligibility with Patient Financial Clearance can help your organization increase productivity, improve collections and boost patient satisfaction.
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.
Yale New Haven Health (YNHH) established a goal to elevate the patient financial experience by compassionately educating patients about the finances surrounding their care, and educating staff on the tools and methods for delivering that message. YNHH embarked on a two-year patient financial advisory initiative, including patient and family advisors, to hear opinions and learn valuable information directly from consumers. According to Sharlene Seidman, Executive Director Corporate Business Services, with Yale New Haven Health: “We needed a consumer-focused price transparency strategy that would bring us on par with other industries, like retail. Our goal was that when patients discuss their overall YNHH experience, it is not just reflective of their clinical care, but their financial care as well.” Since going live with Eligibility and the Epic integration in May 2016, YNHH has made major strides toward meeting its pre-service excellence goals in four key areas 1) the right technology, 2) best practices, 3) patient interaction/engagement, and 4) employee culture and education. Read the full case study here