Tag: patient payment

Experian is one of three credit bureaus to remove cleared medical debt from consumer credit scores, as of July 1, 2022. Previously, debts that were sent to collections would remain on patients’ credit scores for up to seven years after they’d been paid, making it harder to secure credit cards, loans and housing. Patients will also have double the time to manage unpaid medical debt before it appears on credit scores (up from six months to one year). Unpaid bills under $500 will no longer appear at all. It’s great news for the millions of Americans burdened by medical debt and financial stress and is one step to improving patient payments. The measures are expected to remove nearly 70% of medical collection debt from consumer credit reports. In a joint statement, Experian, TransUnion and Equifax said: “Medical collections debt often arises from unforeseen medical circumstances. These changes are another step we’re taking together to help people across the United States focus on their financial and personal wellbeing. As an industry we remain committed to helping drive fair and affordable access to credit for all consumers.” Healthcare providers can support efforts to ease financial pressures on consumers (and protect their own profit margins) in two major ways: by introducing transparent pricing and improving the patient payment experience. Help patients plan and understand medical bills with price transparency tools  July 1 also saw the implementation of the new Transparency in Coverage Final Rule, which places new responsibilities on health insurers to share negotiated rates for covered items and services. In theory, providing upfront estimates of the cost of care allows patients to make more informed decisions about their healthcare and plan for forthcoming bills with more confidence. In practice, it’s easier said than done. A report from August 2022 found that only 16% of hospitals are compliant with the earlier Hospital Price Transparency Rule. Non-compliance penalties aside, it makes good financial sense to help patients understand and plan for their medical bills: 9 out of 10 providers recognize that when patients have upfront estimates, they’re more likely to pay in full and on time. Digital and automated tools can make this easier to deliver. With Patient Payment Estimates, patients get a simple breakdown of their expected costs delivered straight to their mobile device, so they can plan – and even pay – in advance of treatment. Of course, estimates are only useful if they’re accurate, so this solution pulls from real-time price lists, payer contracts and benefits data so that estimates are as close as possible to the final bill. Provide an “Amazon-inspired” patient payments experience When it comes to patient payments, consumers want the “Amazon experience” – personalized payment options, easy-access digital payment methods, and above all, choice about when and where to pay. These three trends quickly gathered ground during the pandemic, and are set to outlast it. Providers looking to up-level the patient payments experience can’t afford to omit digital and contactless payment options. To help deliver this, Experian Health offers a menu of self-service, mobile-optimized payment solutions. For example, with Patient Financial Advisor, providers can help patients take control of their financial journey through a simple text-to-mobile experience. Patients get a text message with a secure link to details of their estimated financial responsibility and links to user-friendly payment tools. They can also be advised on appropriate personalized payment plans. Support patients to manage healthcare payments  For some patients, pricing estimates may influence their decision to access care in the first place. A new collaborative report by Experian Health and PYMNTS, released in July 2022, found that nearly 50% of consumers have canceled a healthcare appointment or procedure due to the high cost of medical treatment. The study also found that three-quarters of millennials canceled a healthcare appointment after receiving a high-cost estimate, as have 60% of consumers living paycheck to paycheck. Providers can use digital tools to identify patients who may need more assistance when it comes to paying for care and assign them to the appropriate pathway. Patient Financial Clearance screens patients automatically prior to or at the point of service to see if they qualify for financial assistance or charity support. It determines how likely a patient is to pay out-of-pocket expenses, and can calculate the optimal payment plan based on the patient’s specific circumstances. Another option is PatientSimple, which offers a user-friendly self-service portal to help patients apply for charity care and keep track of balances and payment plans. Of course, a huge amount of financial worry can be eliminated by simply tracking down missing or forgotten coverage, so the patient can relax knowing their bills will be covered. Coverage Discovery runs automated coverage checks across the entire patient journey to minimize accounts sent to collections and charity. In 2021, Coverage Discovery tracked down billable coverage in nearly 3 out of 10 self-pay accounts, amounting to more than $66 billion in additional revenue. Providers that create a patient-centered payments experience will not only deliver a better service to those needing care, but will be better placed to meet changing legislative requirements and strengthen their own revenue cycles. Find out how Experian Health’s digital patient payments solutions can help healthcare organizations transform the patient financial journey from a maze of dead ends and obstacles to one that’s clearly mapped out and simple to navigate.

The final blog of our post-COVID-19 patient journey series explores how patients have come to expect convenience, flexibility and transparency when paying for healthcare. How can providers ensure the real-life patient payment experience delivers? Read the full white paper here. Despite creating a more transparent approach to healthcare pricing, medical bills remain a major concern for many Americans. Nearly three in ten worry about the cost of healthcare. The prospect of an unanticipated and unaffordable final bill looms large over their entire healthcare experience, exacerbated by the job losses and insurance changes that left many on unsteady financial ground during the pandemic. Patients aren’t only looking for greater certainty about what they’ll owe, they also want the payment experience to be easier. The pandemic created a new baseline in digital patient access and pulled healthcare closer to other service experiences, where digital and contactless payment methods are the norm. To ease patients’ concerns and meet consumer expectations, providers should focus on redefining payment operations through the eyes of the patient. Patients want to know about their medical costs upfront so they can prepare. Experian Health’s State of Patient Access 2.0 survey found that nine out of ten providers agree that this also increases the likelihood that bills will be paid. They want quick and convenient ways to pay and utilize digital apps with user-friendly interfaces. They don’t want a one-size-fits-all approach to their healthcare experience ­– and that includes the payment process. Personalized estimates, payment plans and proactive reminders can all help patients feel confident about their medical bills. The right tools exist to help providers create a great patient experience and reduce the amount of revenue lost to bad debt – it’s all a matter of integrating those tools into existing systems. Help patients plan for bills with transparent pricing According to a study by Pew Research, around half of nonretired adults feel the pandemic has made it harder for them to reach their long-term financial goals. Many patients are keeping a closer eye on household finances in the wake of COVID-19, so helping them to understand their bills from the onset is key. This can help providers enroll patients in the right payment plans, and will lead to smoother patient collections. Accurate, upfront estimates should be utilized to improve the patient payment experience. Patient Payment Estimates give patients a clear cost breakdown straight to their mobile, so they can plan accordingly for out-of-pocket payments. Providers that implement these solutions now will be better prepared as price transparency legislation continues to evolve and grow. Offer flexible payment methods for faster payments Accurate estimates are just the first step: next, providers should make it as easy as possible for patients to pay their bills. Healthcare has typically lagged behind other industries when it comes to quick and convenient digital payment options. However, the pandemic nudged consumers and providers alike to embrace alternate payment models for medical bills. Many patients want to continue using digital and contactless payment methods – including credit cards and mobile payment apps. With a service such as Patient Financial Advisor, providers can direct patients to an appropriate and flexible payment plan, as well as secure ways to pay, without the need for multiple patient calls. Create a personalized payment experience with third-party data and analytics These tools are effective because they enable personalized experiences for every patient. Some patients may prefer to pay in full before they come in for care, while others may need to pay in installments. Some may prefer to pay via a mobile app, while others may choose to pay in person with their credit card. Certain patients may prefer to receive statements and other communications via email, while others will want to speak to an advisor on the phone. A personalized approach not only creates a better patient experience but also increases patient payments and reduces providers’ cost to collect. Achieving this requires access to accurate and reliable third-party data that paint a fuller picture of an individual patient’s needs and preferences. With consumer data that draws on lifestyle, demographic, psychographic, behavioral and financial information, providers can tailor the payment experience to make it as accessible and frictionless as possible. Similarly, Collections Optimization Manager draws on multiple datasets to check coverage information, segment and prioritize patient accounts, and use staff resources efficiently to maximize revenue recovery. Heather Grover, VP of Product Management and Consulting – Patient Payments and Collections, says, “Clients seek processes that are not only tailored to each patient’s unique situation but one that helps automate their collections and payments workflow. Minimizing the use of resources in today’s environment – whether IT, operational or call center – helps lower the cost of collections while delivering a positive patient experience.” Find out more about how Experian Health’s suite of patient estimates and payment tools can help your organization offer a personalized and compassionate financial experience. Missed the other blogs in the series? Check them out: 4 data driven healthcare marketing strategies to re-engage patients after COVID-19 How 24/7 self-scheduling can improve the post-pandemic patient experience COVID-19 highlights an acute need for digital patient intake solutions Automated prior authorization: getting patients the approved care they need Getting a holistic picture of patients with social determinants of health 3 data-driven denial management strategies for faster claims processing

There are a number of topics that draw a full house for a webinar, but the recent “Unpacking the No Surprises Act” presentation produced by Experian Health was exceptional in its attendance. Participants listened intently to the general parameters and compliance criteria that make up the regulation and what it is intended to accomplish. More than 130 questions poured in during the 1-hour webinar and they were still coming in as the event closed. Read our blog to learn more about the No Surprises Act. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more.   The Big Takeaway: there are a lot of questions from across the spectrum of healthcare participants. We looked through those that were submitted during the webinar, pulled together the ones that were similar, and grouped them into categories. Then we asked the expert we’ve worked with to better understand the No Surprises Act – Stanley Nachimson, principal of Nachimson Advisors* – to shed more light on some of the most common inquiries.** In another blog, Nachimson also answers your FAQ about the Good Faith Estimates. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. GENERAL SCOPE Who does the regulation apply to? Insured? Uninsured? The No Surprises Act is meant to protect the uninsured, self-pay patients and those covered by commercial insurance. It DOES NOT apply to government-reimbursed care, i.e., Medicare and Medicaid – essentially because balance billing is already prohibited by these payers. On the other side of the coin, the regulation generally applies to all providers of healthcare. Is this restricted to “emergency care” and has emergency care been defined? The regulation was established to make sure patients are only responsible for in-network charges related to emergency services or scheduled services, in any hospital. As for the definition of “emergency,” the regulation defines that in the Prudent Layperson language, which defines an emergency medical condition as manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: a) placing the patient’s health in serious jeopardy; b) serious impairment to bodily functions; or c) serious dysfunction of any bodily organ or part. Does the No Surprises Act supersede state laws? The federal regulation is the default in states where there are no similar laws to protect against balance billing. In states that do have laws addressing this, NSA takes priority when the state law provides less protection to the patient. Also, in states with No Surprise regulations already in place, the federal law defers to state law as to how much fully insured plans must pay a provider for surprise OON services, rather than requiring arbitration mandated by the federal regulation. Is there an explanation of how this will be enforced? Enforcement procedures are still being worked out, as several entities are impacted. Three levels of enforcement have been proposed: State enforcement – states will have primary enforcement responsibility and CMS would step in for states that will not enforce the law or “fail[s] to substantially enforce” the law Civil penalties (at $10,000 per violation) Possible mechanisms that could initiate enforcement actions, which have been discussed, include patient reporting tools and market conduct investigations initiated by CMS. OPERATIONAL IMPACT What are the primary provider workflows impacted by the No Surprises Act? The most impact will be around scheduling, estimates and producing a good faith estimate (GFE). The systems and solutions in place to determine eligibility and coverage will have additional pressure for accuracy. At this point, if necessary or desired, the mechanism for securing patient consent for OON services will come into play, too. The timing requirements of the law’s expectation of when a GFE will be provided put the front-end operations under a microscope. The “convening provider” challenge of which entity will be responsible for assembling the GFE is a major issue.  The convening provider must present the GFE in a standard format to either the health plan for insured patients; or to the patient in a manner that is clear and understandable stands to require substantial modifications to workflow. The most recent guidance from CMS states that there will be a one-year postponement in enforcing the rules, for uninsured patients, requiring a provider to get estimates from other providers involved in the care. Are office visits included in the regulation? Radiology? Lab work? It appears to be so. The industry is questioning the required range of services.  Any Advance Explanation of Benefits that contains out-of-network providers must include information on how to find in-network providers for those services.   This is definitely one area of the law that the healthcare community is looking to help shape. Is there a best practice for identifying OON status? Most providers should be aware of their network status for any health plan.  That is going to be a question answered at the medical system and very likely individual provider facility level. However, determining the network status of other providers may be a problem.  Most health plans have provider directories available for their members or on their websites.  There won’t likely be a “standard” other than the very clear expectation of the law that no one will be balance billed for any care received that is OON, unless that is consented to by the patient. The systems and communications with the payers and protocols required to meet this compliance standard are going to be unique to different facilities. It sounds oversimplified, but the best practice may be not to balance bill a patient for the care they receive without their consent. SPECIFICS Will there be standardized documentation provided by CMS and, if so, will they be required? No matter the document format, there is a set of requirements for patient notices. These include: A statement that the provider or facility is OON (if that is the case) An itemized, good faith estimate of the cost of care Information on prior authorization and utilization management limitations The notice must be in a format the patient can understand and is accessible (i.e., preferred language and apart from other documents). A variety of model forms and notices are available on the CMS “Overview of Rules and Fact Sheets” page: Standard notice & consent forms for nonparticipating providers & emergency facilities regarding consumer consent on balance billing protections: Download the Surprise Billing Protection Form Model disclosure notice on patient protections against surprise billing for providers, facilities, health plans and insurers: Download Patient Rights & Protections Against Surprise Medical Bills Paperwork Reduction Act (PRA) model notices and information collection requirements for the Federal Independent Dispute Resolution Process: Download Model Notices and Information Requirements Paperwork Reduction Act (PRA) model notices and information collection requirements for the good-faith estimate and patient-provider payment dispute resolution Download Model Notices and Information Requirements Additionally, The Department of Labor published a Model Notice link on its No Surprises Act overview page. Which entity is considered the “lead” and responsible for coordinating the GFE, consent forms and other documentation required to show compliance? The “lead”, or “convening provider” entity is widely expected to be the scheduling provider but that has not been established officially. This is another of the areas where input is needed from multiple stakeholders. What parts of the law have been postponed? Good faith estimates to INSURED individuals have been postponed "until rulemaking to fully implement this requirement…is adopted and applicable." The delay for insured individuals was the result of a general expectation that it is not possible for payers and providers to stand up necessary systems to achieve this by Jan. 1, 2022. The distinction was made that insured patients have means of recourse if they receive an incorrect estimate. Similarly, advanced explanation of benefits (AEOB) is expected to be delayed until the data transfer systems and other requirements to provide an accurate AEOB to the patient are in place. It is expected that short-term remedies to this will be put into effect by HHS. It is important to note that these delays in enforcement do not change the core of the rule, which prohibits balance billing of OON care and services that a patient is unaware of and does not consent to. On-Demand Webinar: “Unpacking the No Surprises Act” - October 20, 2021 Listen in as Roger Johnson, VP of Payer Solutions at Experian Health, and Stanley Nachimson, Health IT Implementation Expert, help providers get up to speed on what they need to do to comply with the No Surprises Act in this 60-minute session. This on-demand webinar will help your organization make sense of the new regulatory requirements and provide strategic recommendations on how to prepare. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of November 18, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey - including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.

A little over a year ago, Experian Health surveyed healthcare providers for a snapshot of their views on the digitalization of patient access, and the importance of healthcare collections. At the start of the COVID-19 pandemic, patient collections emerged as a top priority, the result of rising unemployment and competing consumer demands that impeded patients’ ability to pay. By June 2021, provider attitudes had changed. Our follow-up State of Patient Access 2.0 survey revealed that patient collections were no longer the number one concern for healthcare providers. Patient perceptions of the billing process have improved too. In our latest Interview with the Expert, Matt Baltzer, Senior Director of Product Management at Experian Health, explains why providers feel more confident about patient collections. He also discusses how automated healthcare solutions can help providers shore up these gains and optimize healthcare collections – especially as consumer behavior returns to pre-pandemic patterns. Watch the interview below:   Why are healthcare collections no longer the number one concern for providers? In the six months between the two surveys, the number of providers saying they were “concerned or very concerned” about collecting payments from patients dropped from 50% to 41%. Baltzer explains that during this time, collection rates were relatively steady (when adjusted for volume), and providers received fewer calls about patient balances. Currently, the bigger concern for both providers and patients is to determine patients’ coverage status quickly and accurately. There are three main reasons for this shift. Firstly, multiple rounds of stimulus payments issued by the government helped consumers pay down their debts, including medical bills. Secondly, the pandemic caused a drop in consumer spending on travel, entertainment and dining out, which meant credit card usage was lower than pre-pandemic levels. Consumers had more cash available to pay healthcare bills. And thirdly, employment rates have started to recover. Around the time of the first survey, providers were faced with a surge in patients who had suddenly lost employer-based coverage, but as unemployment levels improve again, this is less of an issue. Those still affected by job losses have been able to access expanded government support, such as Medicaid. How should providers prepare as consumer spending returns to pre-pandemic levels? As Americans start to return to previous consumer habits and routines, household spending is likely to increase, which could squeeze medical bills again. Baltzer explains that “as we see stimulus programs winding down, and discretionary spending options increase, we can expect to see an increase in the utilization of revolving credit lines. For most consumers, that will mean it’s more difficult to meet unplanned out-of-pocket obligations.” Prior to the pandemic, a survey by the U.S. Federal Reserve found that 40% of Americans struggle to find $400 to pay for an unexpected bill. This means providers may not be able to rely on the steady collection rates seen in recent months. While efforts to improve transparency will help patients prepare for possible financial obligations, many providers are going further, implementing the right data, tools, and strategies to understand and address each consumer’s unique situation, making it as easy as possible for patients to pay. Baltzer says: “Data can help drive attention to the accounts with a higher likelihood to pay. This means you can identify those who just need a little more time to pay, and then help those truly in need of charity support. Things can change quickly, and having fresh, accurate data will be essential. Now is not the time to take our eyes off the ball, as the game may shift quickly.” With access to reliable and comprehensive consumer data and automated patient collections solutions, providers can tailor the patient experience according to individual needs and preferences. They can create a more empathetic financial experience, with upfront pricing estimates, personalized payment plans and flexible payment options. Not only will this be more desirable for patients, but it will also optimize healthcare collections, improve operational efficiency and increase the chances of more bills being settled in full. How can optimizing patient collections offset recent staffing challenges? Staffing shortages remain a growing challenge for healthcare providers. According to Baltzer, technology and automation can help ease the pressure on collections teams. He says, “Automation is key. Providers are being challenged to make the most of limited staff resources, especially for patient collections. It’s important to focus staff attention on the accounts most likely to pay. That means filtering out accounts that might be bankrupt or deceased and using automation for manual tasks – such as checking for charity eligibility or cleaning up patient records. Best-in-class providers are increasingly leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter.” Collections Optimization Manager can help organizations deploy a targeted approach to patient collections, using data and analytics to segment, screen and monitor accounts. By optimizing on the back end with user-friendly interfaces and efficient workflows, staff can focus their efforts on the accounts that need the most attention. On the front end, Patient Outreach solutions can help patients take control of their own financial journey with timely bill reminders and self-pay options, and requires minimal staff intervention. Automated text and IVR messages that connect directly to billing software ensure that more accounts are settled without adding to the organization’s headcount. Watch the full conversation, and download the State of Patient Access Survey 2.0, to find out more about how Experian Health can help your organization spot new opportunities to optimize healthcare collections.

Rising medical debt, now a staggering $140 billion, is the largest source of debt for American families. A large portion of this is a direct result of surprise billing, with a third of insured adults saying they’ve received an unexpected bill in the previous two years. What’s no surprise, then, is that two-thirds of US adults worry about being able to afford these unanticipated medical bills. It’s a problem that concerns so many patients that it now has the attention and action of both state and federal governments. To help solve this problem, Congress signed the No Surprises Act into law. Experian Health can help your healthcare organization navigate the regulatory landscape  and implement solutions ranging from transparent, patient-friendly estimates to our all-new FREE No Surprises Act (NSA) Payer Alerts Portal.  The No Surprises Act, effective January 1st, 2022, aims to protect consumers from at least one contributor to the problem: unexpected bills for out-of-network care in emergency and non-emergency settings. Around a fifth of emergency claims and a sixth of in-network hospital stays include an out-of-network bill, often due to emergency or ancillary care. Since patients lack meaningful choices when it comes to choosing these unexpected services, they have no option but to pay up or face negative marks on their credit reports. Typically, while health plans cover some of the bills, patients will still be responsible for the remaining balances. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more. By enforcing better price transparency and consumer protection, the new regulations will help to create better patient experiences and ensure that fewer bills are written off to bad debt. However, according to a recent survey conducted by Experian Health, only 72% of providers are familiar with the No Surprises Act. That’s not all - only 40% of respondents are moderately confident their organization will be able to solve for the No Surprises Act. Payers and providers must act now to ensure their processes are ready to comply with the changes. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. Tackling the price transparency problem with the No Surprises Act Healthcare pricing has been under the spotlight for a while, with several new regulatory measures introduced over the last few years. The new Act, which was signed into law under the Consolidated Appropriations Act of 2021, builds on previous federal actions to empower patients by giving them greater access to healthcare cost information. Come January 2022, balance billing will no longer be permitted for out-of-network emergency services, out-of-network air ambulance services, and out-of-network non-emergency services provided at in-network facilities. Insurers must cover emergency services without any prior authorization, regardless of whether the provider is within the health plan’s network, and patients should expect to pay the same as in-network services. The Act requires both providers and health plans to help patients access healthcare pricing information, and providers must provide consumers with tools to get better price estimates, including a “Good Faith Estimate” covering all relevant codes and charges. The Act sets out a process for health plans to reimburse providers and an arbitration path in the event of disagreement. Summary of provisions in the No Surprises Act: Protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network facilities Holds patients liable only for their in-network cost-sharing amounts, and requires that the patient’s share cannot exceed in-network rates without patient consent Provides guidance for how providers and insurers can negotiate fair reimbursement for out-of-network services Includes the requirements that providers submit Good Faith Estimates to payers and that payers utilize those estimates to create and provide Advance Explanation of Benefits to members. However, enforcement of this requirement has been delayed until more guidance can be provided related to standards for the transmission of these files (as of October 2021) What do providers need to do now to prepare? Creating a “no surprises” billing experience will require payers and providers to make major process changes. Roger Johnson, VP of Payer Solutions at Experian Health, says, “The new regulations require the industry to innovate significantly in a very short timeframe. Determining network status is a huge challenge for providers, as is engaging patients electronically pre-service. There will also be challenges in tracking and submitting consent forms, producing Good Faith Estimates, applying appropriate cost-sharing, billing, payment reconciliation, and the new dispute resolution process.” See what Roger had to say in our Interview with the Expert: CMS has provided a list of documents and requirements for patient notices. These include: A statement that the provider or facility is OON (if that is the case) An itemized, good faith estimate of the cost of care Information on prior authorization and utilization management limitations The notice must be in a format the patient can understand and is accessible (i.e., preferred language and apart from other documents). A variety of model forms and notices are available on the CMS “Overview of Rules and Fact Sheets” page: Standard notice & consent forms for nonparticipating providers & emergency facilities regarding consumer consent on balance billing protections: Download the Surprise Billing Protection Form Model disclosure notice on patient protections against surprise billing for providers, facilities, health plans and insurers: Download Patient Rights & Protections Against Surprise Medical Bills Paperwork Reduction Act (PRA) model notices and information collection requirements for the Federal Independent Dispute Resolution Process: Download Model Notices and Information Requirements Paperwork Reduction Act (PRA) model notices and information collection requirements for the good-faith estimate and patient-provider payment dispute resolution Download Model Notices and Information Requirements Additionally, The Department of Labor published a Model Notice link on its No Surprises Act overview page. Experian Health is engaging with industry partners to clarify the regulations and collaborate with clients to adapt workflows for a smooth transition. Find out more in our on-demand webinar. What price transparency tools are available for healthcare organizations?  In the meantime, various price transparency tools exist to help providers meet ongoing regulatory requirements and create a better patient experience with easy-to-understand cost breakdowns. For example: Patient Payment Estimates give patients clear and accurate estimates of authorized services before, or at, the point-of-service, so they feel more in control of their financial obligations. With a user-friendly interface, the tool helps patients plan and pay their bills – while directing them to appropriate financial assistance options. And because it’s automated, hospital staff will no longer need to manually update price lists. For providers, this tool can create an on-demand Good Faith Estimate using out-of-network benefits. Patient Financial Advisor is a text-to-mobile service that lets patients see their estimated costs of care before they come to the hospital. This solution provides a full breakdown of the procedures, as well as a total estimated amount based on in-network benefits. Registration Accelerator has the ability to collect provider forms and return them back to the client’s document imaging system. ClaimSource can identify claims that are at risk, prior to being submitted to payers. Claim Scrubber can identify claims at risk from various angles, such as: Non-Network payers Non-participating providers Services provided without an approved authorization Services provided outside of the approved authorization criteria While regulatory change can seem daunting, price transparency is already trending in the right direction. Our second State of Patient Access survey indicated that both patients and providers want more price transparency. Nine out of ten providers told us they agree that price transparency improves the customer experience and increases the likelihood that patient bills are paid. The regulations may be a catalyst for change, but making it easier for patients to understand and pay their bills continues to pick up momentum. That’s good news for patients’ wallets and for providers’ bottom lines. Download our on-demand webinar, "Unpacking the No Surprises Act," to learn more about how the new regulation will impact patient and provider workflows.

Collections were tough even before COVID-19 hit. Provider’s bottom lines were already strained, and the high-deductible trend continued, putting patients on the hook for a bigger chunk of their medical bills.   A highly volatile – but improving – employment environment hasn’t helped, and some patients’ ability to pay hasn’t kept pace with their growing financial responsibilities. Many have new health plans, lapsed coverage or are more focused on other debts, making collections even less predictable. Providers may also feel that payer policy changes haven’t made recouping lost pandemic revenue any easier, with some losing two whole business days per week to completing prior authorizations. It’s no wonder that nearly one in five providers have overhauled their patient collections strategy in the last year.   Now, after a year of the pandemic’s impact on revenue, three dominant trends continue in this space: rising patient balances, an accelerated move toward innovative payment experiences that are moving toward digital engagement as a preferred option to paper or “payment at the counter,” and a realization that compassion is a key factor in solving this challenge.   Avoiding new pitfalls in patient collections   Go-to strategies for improving patient collections before the pandemic might have only included offering more patient payment options, doing more to check for missing coverage, or focusing efforts on patients who are most likely to pay. These are sensible options but, if implemented poorly, they’re more of a band-aid than a cure. Some shortcomings include:   Models relying on historical payment data don’t show the full picture Providers know that focusing their collections efforts on patients who are most likely to pay is the most efficient approach. But determining a patient’s ability to pay on historical payment data alone is likely to be unreliable.   Experian Health’s research suggests that when a collections model relies on historical data alone, around 50% of accounts end up being worked on the basis of no data at all. New accounts are assigned to a “highly likely to pay” segment, whether or not that reflects the reality of their situation. This model costs four times more than utilizing Experian Health’s Collections Optimization Manager, which can predict the ability of patients to pay, even without historical payment, by using multiple data sources.   Collections based on limited data will require more resources to work more accounts, but which ultimately will collect the same as collections based on multiple data sources.   Beware of artificial claims about artificial intelligence To streamline workflows and avoid losing staff hours to inefficient processes, many providers are turning to automated patient collection solutions. Artificial intelligence in healthcare is an exciting prospect, but not all solutions are what they seem.   Matt Baltzer, Product Director at Experian Health, says:   “Many collections tools claim to use artificial intelligence when they’re really using basic automations based on incomplete data. Since the quality of the output is only as good as the data that’s put in, the insights generated by these tools will be severely limited.”   To solve the collections workflow challenge, providers need an end-to-end strategy that integrates multiple high quality data sources, intelligent analytics and a responsive platform that learns and adapts in order to prioritize patients and communicate with them in a way that makes collections easier. Cash payments and price transparency can be part of, but not all of, the solution One way to smooth out a bumpy revenue cycle is to offer discounts to patients who pay in cash. It saves on admin costs and guarantees at least some of the bill will be paid. While this makes sense for minor ailments, admin and treatment costs for chronic conditions and major medical events remain persistently high. A resilient collections strategy needs to work across the board, addressing the many treatments, procedures and care plans that providers deliver and manage every day.   Requirements for improved collections, post-COVID-19 The cohesive, integrated model that providers need has the following key elements:   Multi-data sources for comprehensive analysis Optimal collections modeling uses different sources of data to build a more reliable prediction about a patient’s ability to pay. Combining credit data, behavioral modeling and socio-economic insights can help providers better understand their patients’ financial situation and group them accordingly – quickly and accurately.   Convenience and clarity for patients and staff Automated workflows with easy-to-use interfaces will make collections easier for staff, and eliminate time-wasting manual tasks. At the same time, a smoother, more targeted collections process means staff can engage with patients on the basis of accurate information, with fewer (and less stressful) calls and emails.   Advanced data analytics and automation for fewer errors and denials In-depth data analytics allow providers to screen and segment patients quickly to help prioritize accounts by payment probability, to achieve a higher rate of collections. A tool such as Collections Optimization Manager will evaluate collection performance in real-time, to help providers forecast patient payments and avoid bad debt. Expert consultancy support to stay on top of industry trends With the payments landscape in constant flux, having an expert on hand to help navigate the changes and advise on industry trends is a major asset. Experian Health’s team stands ready to help providers monitor and improve collections with industry insights and best practice strategies.   Find out how Collections Optimization Manger can help your organization avoid patient collections pitfalls and reduce lost revenue in the wake of the pandemic.

How did Starbucks lose $1.2 billion in sales during the pandemic, but still exceed revenue expectations in the last quarter? The answer lies in contactless mobile payments. By making it possible for coffee lovers to pre-order and pay for their morning cappuccino through a mobile app, the company was able to offer a safe and convenient slice of normality during the pandemic. While stores were limited to drive-thru and takeout, customers could still get their caffeine fix, but in an easy, socially distanced way. And customers want convenient and contactless ways to pay – as evidenced by $6.2 billion in quarterly sales. Thanks to the app introduced a few years ago, the company has been able to withstand much of the disruption that’s hit the rest of the industry hard. Can healthcare providers learn from Starbucks’ strategy? Yes. Social distancing measures and fears about face-to-face contact are preventing many patients from visiting healthcare facilities and it’s becoming harder for providers to collect payments and maintain a steady revenue cycle. Self-service and contactless payment methods are now a necessity if providers want to remain profitable during these uncertain times. But it’s not just about facilitating payments in the context of social distancing. Even before the pandemic, patients were looking for more convenient ways to manage their out-of-pocket expenses and thinking more like active consumers than passive participants in their healthcare journey. Starbucks’ story shows how prioritizing the consumer experience wins out in the end. So how do providers accelerate collections, ensure patients and staff remain safe, and keep up with consumer expectations? Here are three ways to use pre- and post-service online and mobile payment tools to optimize both collections and consumer satisfaction: 3 ways to improve the patient financial journey with easy contactless payments 1. Empower patients with upfront payment estimates Imagine sending patients an email or text as soon as their appointment is scheduled, with a personalized cost estimate, relevant payment options and convenient ways to pay before they even arrive. Healthcare payments could be as easy as ordering and paying for a coffee! With Patient Financial Advisor and Patient Estimates, providers can do just that. With a single text message, providers can give patients transparency, control and reassurance about what they’re going to owe and how they can settle their bill quickly and easily. 2. Help patients find the right payment plan The pandemic means finances are tighter than usual for many families as well as many organizations, so helping patients manage their bills and get on the right plan pre-service is especially important. With a consumer-friendly online portal, patients can check their balances, manage payment plans and apply for financial support at the tap of a button. Quicker insurance checks will also increase the likelihood of faster payments and minimize the risk of claim denials for providers. 3. Make it easy to pay – before or after treatment Reducing friction at the point of payment is probably the biggest dial-mover when it comes to accelerating collections. If patients can settle their bill at the click of a button, the job is ticked off quickly without too much effort on their part, and with minimal input from providers taff. Why make paying harder than it needs to be? Consider offering patients safe and secure digital payment methods that they can access anytime, anywhere, both before and after their appointment. Post-service, maintain a positive consumer experience with proactive follow-up, timely account information and options to navigate payments from home, if not already settled. The pandemic has intensified the need for healthcare payments to evolve. Contactless and mobile payments can keep revenue coming in the door (even when the real doors are shut). And as Starbucks has shown, consumers expect easier ways to pay. Every day that a patient struggles to pay a bill is a missed opportunity for the bottom line. Find out more about how pre- and post-service contactless payments could help your organization withstand financial turbulence, during the pandemic and beyond.

From airlines to cafés to car manufacturers, businesses across America are scrambling to respond to the challenge of COVID-19. In healthcare, services are being put on pause to protect staff and patients on the pandemic’s front line, leaving health systems to contend with gaps in reimbursements and exhausted cash flows. The problem lies in the sheer number of human touchpoints involved in the typical patient experience: scheduling, paperwork, waiting rooms, treatment, payment…all that in-person interaction just isn’t realistic in the current climate. Digital and mobile technology could be the answer. While digital communication platforms have been growing steadily over the last decade, they’re now a life raft for many providers as COVID-19 forces much of the patient journey online. Megan Zweig, director of research and marketing at Rock Health, says investments in virtual care have already exceeded $3 billion this year: "Without COVID, the story would have continued from last year as this was a healthy, growing space with a lot of momentum behind it. That momentum has turned into incredible urgency and demand for communication, testing, monitoring, care – all of those things done at a distance." This trajectory will likely continue beyond the immediate crisis, as providers prepare for a possible second wave later in the year and patients become accustomed to remote and mobile options. Providers that take advantage of these digital solutions now will be better positioned to optimize the patient journey in a post-COVID world. What could the digital patient journey look like beyond COVID-19? A digital healthcare experience can offer patients more convenience and flexibility while protecting revenue for providers, in the following ways: Scheduling appointments when it suits The first bump in the road for many patients is scheduling their appointment. With many in lockdown juggling home-schooling and home-working, it’s not always convenient to call during office hours. A patient scheduling platform lets the patient book their appointment whenever suits, using the channel they prefer. Before the pandemic, Benefis Health System found 50% of patients chose to book after hours, including for urgent care. We can expect this to increase as even more patients are nudged online. As the threat of COVID subsides, a massive influx of patients will also want to reschedule postponed visits. Automated patient scheduling will reduce the pressure on call centers and offer a more efficient consumer experience. Reducing registration gridlock with automation Patient access is often rife with avoidable stress – queues, unnecessary forms and manual data entry, resulting in costly errors and repeated work. Instead, providers can streamline the process by allowing pre-registration tasks to be completed online, and automating patient access with a mobile intake experience. Completing as many tasks as possible outside of the provider’s office will help minimize face-to-face contact, keeping everyone safe. Opening up access to telehealth There’s no getting around the fact that most care needs to be delivered in person. Telemedicine offers an effective way for patients to seek care from the safety of their own home. Video calls can be used for general consultations, remote monitoring of patients with respiratory conditions, and even supporting patients with chronic conditions to adhere to care plans. As the government allocates $20 million to support access to telemedicine in response to COVID-19, up to 54% of patient encounters are expected to take place remotely in the near future. Many of these patients will choose to stick with telemedicine, even when in-person options return. [Remember to check out our free COVID-19 Resource Center, where you can get free access to telehealth payer policy alerts to help avoid payment denials and delays.] Making contactless payment the easy option Contactless payment through apps such as Apple Pay and Venmo are gaining popularity as consumers try to avoid exchanging cash and cards. But can it be used in hospitals? In short, yes. Not only does Experian Health’s Patient Financial Advisor offer patients a way to make secure – and socially distanced – payments, it allows providers to give a breakdown of estimated costs using real-time information. Patients get updates on their mobile or through their patient portal. These digital alternatives not only offer a more convenient patient experience, they can also allow providers to collect payments faster and in full. Contact us to find out how digital health solutions can help your organization adapt to the new normal, and provide a better patient experience now and beyond COVID-19.

Imagine being able to offer your patients a financial experience that doesn’t stress them out. That makes patient billing quick and simple. That knocks off a few minutes from each patient registration. And that even boosts your revenue. These are just some of the benefits attendees at last week’s Cerner Health Conference were considering as they discussed opportunities for faster innovation, smarter working and transformation in the future of healthcare technology. When it comes to working smarter, attendees seemed to agree that one aspect of the healthcare experience comes out top for providers and patients alike: the cost of care. This is especially true because patients are increasingly responsible for paying their healthcare costs. And since the way services are reimbursed is constantly changing, patients are often left in the dark about how much they’ll have to pay, or how they’ll be able to afford it. Patients are struggling under the weight of financial burden We know this can have serious implications for their physical, emotional and financial health. A recent survey by the Nationwide Retirement Institute showed that as many as one in three patients aged 25-45 are delaying medical care because they’re worried about the cost, instead keeping their fingers crossed and hoping that the issue will disappear by itself. A third shop around for better prescription prices, with many not taking their meds as often as instructed in order to save money. More than half of patients wouldn’t be able to afford an unexpected bill over $1000, while a staggering 530,000 families are bankrupted by medical costs every year. Healthcare providers often end up bearing the burden of uncompensated care, or waste valuable time and resources working to uncover missing or undisclosed coverage. Either way, all this wrangling for payment has a major impact on the organization’s bottom line as well as the patient financial experience. To tackle some of these challenges, we’ve teamed up with Cerner® to support healthcare organizations to provide more compassionate and convenient billing practices. At last week’s conference, we launched the Cerner Consumer Financial Engagement suite, a newly embedded experience within Cerner’s Consumer Framework that will optimize the billing process for both patients and providers, powered by Experian® data. 3 ways the Cerner Consumer Financial Engagement suite can optimize your patient collections One of the biggest pain points for patients when it comes to managing their healthcare bills online is needing to switch between different systems for different administrative tasks. This new partnership will let patients who use the Cerner Consumer Framework access and manage all aspects of their online healthcare account in one place, creating a more convenient financial experience. The new tool will help providers improve patient collections in three ways: Smarter patient engagement When you have insights into your patients’ financial circumstances and propensity to pay, you can make more informed decisions about how to approach collections and get them on the right program from the start. Using Experian’s industry-leading datasets, providers will be able to use the Consumer Financial Engagement suite to spot patients who may benefit from alternative payment plans or financial assistance and make personalized offers that are compassionate and relevant. Giving patients a one-stop-shop for managing bills Patients are coming to expect a better experience – similar to what they might see in online retail and financial services. When it’s easy for them to settle their bills, they’re more likely to conclude their healthcare journey on a positive note and feel reassured about sticking with your organization the next time they need care. With an all-in-one patient dashboard showing current billing information, insurance deductible status, transparent cost estimates and tools to activate pay plans or financial assistance, the Cerner Consumer Framework creates a frictionless and transparent billing experience, leading to fewer late or unpaid bills and more satisfied patients. Simple and efficient collections When it comes to payments, proactive communication can help ward off some of the sticker shock that comes with unanticipated treatments and bills. The new financial engagement tool uses a simple interface that makes medical billing clear and quick for patients. When consumers aren’t put-off by the technology, they’ll be more likely to act promptly to get billing out of the way. In addition, providers will be able to add their own branding, so the patient experience is consistent from start to finish. Creating a positive patient financial experience powered by reliable data In today’s climate of increasing costs, big data and healthcare consumerism, data and analytics are now the driving force behind an efficient revenue cycle. Person-centered healthcare services that prioritize quality and patient outcomes should be a given, but the financial experience is an integral part of the total equation. This is especially true when we consider that the three biggest pain points for consumers during their healthcare journey are all related to payments! Learn more about how data-driven technology, such as the new Cerner Consumer Financial Engagement suite, can help you offer patients a better financial experience and optimize revenue at the same time.