Tag: Revenue Cycle Management

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Consumers are bearing a bigger burden of healthcare costs than ever before. As the third largest payer behind Medicare and Medicaid, many patients find themselves struggling to foot the bill, with implications for hospitals and health systems. According to a TripleTree report published late last year, consumer payments will reach $608 billion by 2019, thanks to growing enrollments in high deductible health plans (HDHP), decreasing payer reimbursements, and increasingly personalized insurance plans that come at a premium. Almost half of those under the age of 65 are enrolled in an HDHP. These rising out-of-pocket payments can cast a long shadow on the patient's experience. The payment process is often stressful and confusing, and many are unable to pay without careful budgeting or some form of financial support. And for providers, the growing admin costs of chasing payments can create a serious cash-flow problem. A forward-looking, patient-centered approach to billing is critical. A good starting point for providers who want to reduce friction around payments, optimize revenue and build a positive relationship with consumers is to look at how data and technology can improve customer payment processes. You can do this in three ways: transparent pricing, patient billing tailored to each individual's financial situation, and simplified admin processes all provide greater clarity and reassurance for patients. Make patient billing easier​​​​​​​ with transparent pricing ​​​​New guidelines from the Centers for Medicare and Medicaid Services (CMS) call for hospitals to list chargemaster pricing on their websites, so consumers can make informed decisions about their treatment and plan accordingly. Unfortunately, the complexity of pricing structures and the way it's presented can still be very confusing for consumers. CMS Administrator Seema Verma tweeted that "While the information hospitals are posting now isn’t patient-specific, we still believe it is an important first step & sets the stage for private third parties to develop tools & resources that are more meaningful & actionable." Patients are encouraged to tell the CMS if they can't find pricing info on their hospital's website, using the hashtag #WheresThePrice. However, there’s been a lot of criticism that the CMS requirements do not meet consumer expectations. Health leaders should aim to provide consumers with accurate personalized estimates, using data-driven technology. Most healthcare organizations already have the basic data they need to generate estimates for basic services, including: claims data real-time eligibility and benefits information payer contracts charge description master (CDM) information. Riley Matthews, Senior Product Manager for the Patient Estimate Suite at Experian Health, says: "We're finding facilities are getting backlogged with calls while patients are trying to call in to speak to a live person to try to get an estimate... If a patient is comfortable understanding what they owe, they're going to be much more comfortable paying for their services." Giving patients accurate estimates upfront empowers them to understand their financial responsibility so they can make quicker, better decisions, and improve their overall experience. Personalize patient payment plans for a better patient experience The growth of consumerism in healthcare calls for a friendlier approach to the billing process, both for a better patient experience and to avoid non-payment. This means recognizing each patient as an individual with different needs and tailoring your offer at each stage of the revenue cycle. Some will be able to pay their whole bill up front, while others might need to spread it over a number of months, or seek support from a charity. Issuing the bill and hoping it gets paid isn't going to cut it – you'll be wasting time and money on repeated, unnecessary collection attempts. Instead, why not personalize each patient's payment plan based on their individual financial situation? No surprises for them, no missed payments for you. Insights from credit data can help you identify the best collection approach for each patient, so you can work with them to find financial assistance, set up payment plans in advance, or outsource payment to an appropriate co-payer. Simplify the admin process to improve patient collections These days, most of our life admin is done online, from banking to travel. Healthcare needs to do the same. You can make healthcare payments easier for your patients by giving them access to their accounts online, so they can manage it when it suits them. This is about making the revenue cycle as frictionless and consumer-friendly as possible. Data-driven technology makes it easy for patients to obtain accurate price estimates, set up or modify their payment plans, check their insurance details, combine payments to different providers, and facilitate mobile healthcare payments. Terry Manifesto, a Senior Director at El Camino Hospital, worked with Experian Health to allow patients to access and manage their data through a self-service portal: "We're providing a lot more estimates than we could before, because it's 24/7, on the go - a patient can use it from their mobile device, from their laptop, or their desktop." With healthcare consumerism and outcomes-based care trending upwards, the dynamics of healthcare finance are shifting. A collections approach based on compassion and simplification is the key to building trust and optimizing revenue at the same time.  

Published: May 28, 2019 by Experian Health

A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one.   For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices.   Keeping up with payer contracts   In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex.   The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG's numbers continued to fluctuate until implementing Epic alongside Experian Health's Contract Manager.   Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster.   Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.”   The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials.   Experian Health's team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA's contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes.   Analyzing contracts before signing up   In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It's also able to avoid unfavorable contract terms, as they are easily spotted through analysis.   Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.  

Published: April 16, 2019 by Experian Health

Healthcare organizations have been forced to deal with billing challenges for so long that many might consider the struggle to simply be the price of doing business. Denied claims and contractual underpayments are regular occurrences in the payment cycle. And these issues can cause problems in the rest of the healthcare ecosystem when left unchecked. Fortunately, a robust claim scrubbing solution can reduce costs and speed up reimbursement. Healthcare billing costs can add up quickly. The estimated cost of billing- and insurance-related jobs at one large academic healthcare center ranged from $20 to $215 per patient visit, according to a study published in 2018. For years, the State of Franklin Healthcare Associates (SoFHA) was all too familiar with the challenges of the claims process. In 2010, the organization had to keep 12 full-time employees on its payroll devoted to the correction and resubmission of denied claims. When claims are denied, Crowe reports that it takes an average of 16.4 additional days for a hospital to receive payment. And those delayed payments are costly to healthcare organizations. Without the tools that enable a proactive approach, healthcare organizations' only option is to submit claims and then wait to correct the ones that are denied. SoFHA’s large network of 109 providers included a wide variety of specialties and services, from diagnostic imaging and internal medicine to OB/GYN and family practice. SoFHA needed a flexible presubmission claim scrubbing technology that would identify and correct errors before claims could be submitted. To overcome the obstacles in the claim submission process, SoFHA turned to Experian Health's Claim Scrubber. Claim Scrubber stood out to the group in two ways. The first was the price, as users pay a fixed monthly rate rather than pay for each transaction. The other highlight was the ability to build customized claim edits, which are available to all clients immediately when the tool is deployed. For Amanda Clear, SoFHA’s director of business services, that capability made all the difference. “With Claim Scrubber, I have the ability to go into the system and create my own edits,” Clear said. “Other systems either didn’t accommodate customized edits or required you to call, perhaps pay a fee, and go through a long process.” Plus, Claim Scrubber reduces demands on healthcare provider personnel because the tool comes with around 350 edits maintained by a dedicated content team. Payer-specific edits replace between 60 and 75 percent of an organization’s custom edits right away. Claim Scrubber ensures claims are correct and complete the first time they're submitted. Experian Health regularly updates its system with coding and payer changes. The tool adjusts for coding variances on claims submitted to Medicare, Medicaid, and private insurance companies. It reduces denials and drives down rebilling costs for healthcare organizations. With Claim Scrubber, SoFHA generated a clear return on investment, and the group was able to expedite accounts receivable by 13 percent. Perhaps even more telling was the reduction in full-time claim correction employees that accompanied the adoption of Claim Scrubber — a change that occurred in spite of a growing volume of claims. By auditing claims and spotting errors before submission, Claim Scrubber can ease the burden of claims denials and allow healthcare providers to instead focus on their job of providing the highest-quality patient care. --- Learn more about how we can help you ensure all claims are complete and accurate before submission to the appropriate payer or clearinghouse.  

Published: April 9, 2019 by Experian Health

Healthcare providers should be able to focus on what's important: their patients and the care they need. However, providers and their staff must spend much of their time on administrative tasks. A study by AMA Prior Authorization revealed that providers are spending two business days per week just completing prior authorizations. That doesn't even account for other administrative tasks. Meanwhile, providers rely on more payers and plans than ever before, which is often tied to their clinical performance, and patients are becoming increasingly more responsible for the cost of their care. This is leading to an increase in operating losses per physician of 17.5 percent of net revenue in 2017. Providers must prioritize their revenue cycle efficiency if they want to remain financially solvent in the ever-shifting healthcare field. To safeguard its revenue, Schneck Medical Center in Indiana, the only hospital serving four counties, wanted a way to optimize claims follow-up by identifying and targeting the claims needing attention as quickly as possible. This was especially important because an estimated 10 percent of the population lacks insurance and 13 percent lives in poverty in the primary county the medical center serves. Schneck's goals were to: Ensure denials did not exceed 3 percent of net patient revenue. Achieve the estimated total net preventable denials of $3.2 million or a 2 percent increase to operating margin. Reduce denials by confirming patient insurance eligibility, verifying medical necessity, and obtaining prior authorization when appropriate. Makenzie Smith, director of patient financial services at Schneck, said that industry pressures to reduce healthcare expenses and provide a better patient experience are what drove the healthcare organization to look at the revenue cycle technologies and processes it had in place. A better denials management system The denial management process can be cumbersome, especially for community hospitals like Schneck. It takes up too many resources and far too much time. Schneck was looking for better denial analysis reporting and automation software so it could more effectively manage denials and significantly increase collections. The organization's search led to Experian Health's automated approach to tracking the root causes of denials and identifying the trends in order to improve procedures. The software tool provided a comprehensive solution and allowed Schneck to optimize its claims workflow with remittance detail and analytics. It now helps the medical center identify denials, holds, suspends, and zero pays and uses electronic remittance advice and claim status transactions to identify appeals won or lost with payers. This allows Schneck to identify and target the claims that require immediate attention. The payoff With executive leadership buy-in and support, Schneck created a new, better process for claims denial management by: Reviewing preventable denials with customized queues in real time. Identifying directors with staff responsible for checking a patient's benefits and obtaining prior authorizations. Reviewing all denials over $500 in the revenue cycle department. Establishing a schedule for reviewing denials each month. Schneck's new streamlined process and real-time visibility into denials data has allowed staffers to work on denials more efficiently. The ability to link denials to a specific staff member in a specific department has further streamlined the process. The relationship between the front and back office has improved because both sides have achieved a better awareness of processes. With the right denial analysis and automation, healthcare organizations like Schneck can manage denials effectively and increase collections significantly.

Published: March 19, 2019 by Experian Health

It's no secret that claim denials cost healthcare organizations. They take about 16 more days to pay out than claims that have not been denied. On average, this delay in payment equates to one percent of a healthcare organization’s cost structure.   Final claim denials — or claims in which the payer never pays the provider — lowers a typical hospital’s annual net revenue by 1.9 percent. These tack on additional administrative costs because of the work it takes to close them.   The good news is that 76 percent of claim denials are eventually paid off — but the staff time it takes to get the payments can be costly.   Claims roadblocks   Experian Health recently worked with a large healthcare organization that manages more than 200,000 claims per month, which exceeds $1 billion in claims dollars. The organization has almost 50 hospitals in its network, as well as urgent care and cancer care centers, which creates a large number of transactions and claims to process. This includes Medicare, Medicaid, private insurance, worker's compensation, managed care, and more.   Before partnering with Experian Health, a number of errors were leading to denied claims, including discharge-not-final-billed errors, claims errors, stop bills, late charges, clearinghouse edits, and other factors that created roadblocks. But claims automation helped turn things around.   Automation reduces errors   Automation provides benefits to healthcare organizations and patients because it speeds up evaluation, ensures correct and timely billing, and reduces the number of manual touches needed for each claim.   According to the Council for Affordable Quality Healthcare, manual processes slow down claim reimbursement. People take an average of four minutes to process claims, but automation reduces this to three minutes.   Although a minute doesn't sound like much, it translates to thousands of hours saved for a healthcare organization that processes 200,000 claims each month. Automation also frees up time for billing teams to focus on more pressing tasks.   How organizations can benefit   By automating, this healthcare organization could ensure clean claims by utilizing an expansive library of national payer edits and implementing custom edits. This eased the follow-up process because teams had detailed insight into claims status, an analysis of denial reasons to efficiently process them, and automated workflow and payment posting to handle splits and contractual adjustments.   One of the biggest reasons this healthcare organization partnered with Experian Health was the ease of implementation with its medical records system, Epic. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, found and repaired issues with the system build, and created opportunities for cross-training and centralized reporting.   Long-lasting results   Through this automated process, the healthcare organization now has detailed insight into its claims management process and can monitor rejections data, review effectiveness, and find ideas for even more system automation.   Through its partnership with Experian Health, this healthcare organization has improved its claims metrics across the board. It improved its acceptance rate by 10 percent, and it became an Epic top performer for claims acceptance, averaging a 99 percent acceptance rate. It has also increased its clean, paid claims percentage by over 10 percent.   Start automating to streamline your claims process.

Published: February 21, 2019 by Experian Health

Healthcare runs on revenue, and claims denials can put a big dent into the budgets of healthcare providers — between 5 and 10 percent of claims submitted by healthcare providers are denied. This adds up to billions ­of lost dollars each year for providers in the U.S.   The good news? Ninety percent of claims denials are preventable when healthcare providers automate revenue cycle functions. In fact, providers could gain an estimated $9.5 billion by automating the claims management processes. And money isn’t the only thing to be saved — companies could also have more time to work on other processes.   The problems facing one Oregon healthcare provider   Monitoring claims and cash flow is difficult for any healthcare organization, as the staff at Summit Medical Group Oregon — Bend Memorial Clinic (BMC) knows. Summit Medical Group Oregon – BMC found its team consistently waiting for payer response, which often forced its overall operations to drag.   After 30 to 45 days of submitting claims, if Summit Medical Group Oregon – BMC did not receive payment, staff members would have to reach out to payers to determine whether they had received the claim. They also had to determine whether the claim was in the process of adjudication, as well as any other steps the staff should take in order to get the claim processed, according to Summit Medical Group Oregon – BMC business analyst Sean Schlappy.   These manual processes not only create lags in claims reimbursements, but also take up a lot of staff time. The Council for Affordable Quality Healthcare found that processing claims manually takes an average of four minutes, while processing automated payments takes an average of three minutes. So Summit Medical Group Oregon – BMC decided to implement software solutions to improve acceptance rates.   The tools used for improvement   One product Summit Medical Group Oregon – BMC implemented was Claim Scrubber, which ensures all claims submitted are accurate before they're sent to the payer. Because it can be integrated with most practice management systems, this service allows employees to set up notifications in the healthcare provider's work queue. It also provides detailed dashboards and reports to quickly recognize trends to improve medical coding and reimbursement rates.   Summit Medical Group Oregon – BMC additionally turned to Enhanced Claim Status, which provides employees with status requests based on the payer’s adjudication time frame, improves productivity, and ensures timely and accurate payments. This tool reduces the amount of time staff members must spend interacting with the payer, and it generates work lists of claims with actionable data.   By transitioning most of its coverage information upstream, Summit Medical Group Oregon – BMC was able to obtain more accurate data during the initial patient introduction and registration. Using this technology, Summit Medical Group Oregon – BMC also improved the patient experience.   Using technology for clean claims   After implementing Enhanced Claim Status in conjunction with other services from Experian Health, Summit Medical Group Oregon – BMC gained a 15 percent reduction in accounts receivable days and volume. And the healthcare organization now has a 92 percent primary clean claims rate, and its claims denial rate has dropped to 7 percent.   Integrating several tools is helping Summit Medical Group Oregon – BMC in the long term, Schlappy says. Summit Medical Group Oregon – BMC has increased payment processing and reduced claims denials, and, most importantly, it's producing cleaner charges.

Published: January 30, 2019 by Experian Health

As of January 1, 2019, thousands of hospitals in the U.S. are being required to post an online list of the cost of their services due to a new requirement by the Centers for Medicare & Medicaid Services (CMS). However, amid growing confusion about which fields are required or what format the list of standard services needs to be in, many health systems feel this new law will only create confusion among patients. One health system described the new requirements as, “It would be like walking into a car dealership looking at a new car, asking the salesman how much the car was going to cost and having them hand you the parts catalog. Obviously, when you have the parts catalog, you don't know what parts are in your car or which ones you're going to use or how much labor is going to go into making the car." While posting the list of prices is required by CMS, some health systems have invested in the needed technology to make it easy for patients to shop online for care. For example, in an interview with Modern Healthcare, El Camino Hospital explains they “launched a consumer self-service tool in May 2017, after about a year of development work with Experian Health. Since then, more than 3,000 people have visited the hospital's website, selected one or more of about 90 medical or surgical services they were interested in, entered their insurance information, and received an instant out-of-pocket cost estimate the hospital claims is 95% to 99% accurate.” Health systems like El Camino Hospital know that patients want to avoid costly surprises, and they should be able to understand their financial obligations upfront, including deductibles and copays. In fact, McKinsey research found nearly three-quarters of participants were worried about healthcare expenditures. Legislative help The new CMS requirement is only one of a few initiatives in the works from a legislative standpoint. In an effort to help patients, some members of Congress are trying to bring attention to the topic. A bipartisan group of U.S. senators in 2018 wrote a letter to healthcare stakeholders and experts requesting information in an effort to learn more about price transparency as they considered possible legislation on the matter. Also in the letter, the senators cited the lack of state laws and regulations requiring healthcare providers to make that information available to patients. More than 40 states were cited by the Catalyst for Payment Reform and the Health Care Incentives Improvement Initiative in 2016 because they were deficient in healthcare transparency legislation. And that same report found that some patients were paying thousands of dollars more than others for the same procedures, depending which healthcare provider they used. Alleviating patient stress Transparency in billing creates more satisfied patients because they know how much they will be paying for services, which makes it easier for them to budget. Going to the hospital is usually a stressful time for patients and their families. An easy way for healthcare providers to alleviate that stress is to help patients understand their costs upfront Most healthcare organizations already have the basic data they need to use automated technology to construct estimates for basic services, including claims data, real-time eligibility and benefits information, payer contracts and charge description master (CDM) information. Experian Health has the technology to help healthcare organizations convert this information into patient costs through Patient Estimates. This kind of transparency provides several benefits to both providers and patients. Online estimates published on healthcare provider websites give patients access to the information any time, including late at night and on weekends. And these estimates can be obtained confidentially, so patients who may be uncomfortable asking about certain procedures can find that information on their own. And that helps them be more relaxed about making appointments and scheduling treatments because they have confidence they won't face billing surprises. This feel-better result of having prices at their fingertips has a clear benefit for the healthcare providers as well. Patients are able to plan and pay for services, decreasing unpaid balances for hospitals and other healthcare providers. Ability to budget for healthcare costs Patients who know what to expect can budget wisely and actively take charge of their healthcare bills. They go in with their eyes open, which leads to improved revenue cycle management. In the end, both the patient and the hospital get what they want. With Congress and state legislatures looking at transparency in healthcare, providers can expect to see more of these rules. Healthcare organizations can get ahead of them with software like Experian Health's Patient Estimates. Healthcare consumers don't like surprises in their billing. Price transparency gives them the information and peace of mind they need to secure healthcare services and be assured that they know what they will be paying for them. Learn more about how Experian Health can help you achieve price transparency for your patients.  

Published: January 15, 2019 by Experian Health

Healthcare providers are always balancing a million tasks at once. The most important of these tasks, obviously, is serving patients, which can sometimes crowd out the important but thankless business functions — like keeping tabs on the insurers you're processing. Payers are changing their policies and practices constantly, and those changes are easy to miss when you're focused on everything else you have to do to keep a healthcare organization running. But if a payer policy changes without you knowing, it’s going to cost you. If your denial rate ticks up because of an unknown change in payer policy, you could end up spending thousands of dollars per year to rework those extra claims. The good news, though, is that there’s a tool that can lighten the load. Experian Health’s Payer Alerts service keeps you in the loop about the payer policies and procedure changes you’re too busy to catch. That way, instead of poring over the mergers, acquisitions, and countless other details that affect the insurance industry, you can stay focused on what’s really important — without making sacrifices to your bottom line. How it works With Payer Alerts, every notification you receive is the result of extensive behind-the-scenes work by our software. The program monitors more than 50,000 web pages that payers visit and records any relevant policy changes before preparing an alert for you. The alert contains a detailed summary of those changes and a link to the affected policy. Once you receive the alert, you can just follow the link and make the necessary adjustments to your internal procedures. But given the variety of potential policy changes, those adjustments can be tough to pin down. That’s why every alert categorizes each change by healthcare specialty, allowing you to receive the alerts most related to your organization. And the customization goes further than that.Want an email that describes all relevant administrative changes? Done. Want a web-based portal where you can identify any reimbursement issues? Easy. Regardless of what you need, the alert will be waiting for you in the right platform. Finding ROI in new information Being privy to policy changes without having to sift through insurance jargon can mean a lot for a healthcare organization. “When things change and information is always current, that’s a huge benefit,” says the director of managed care at Rocky Mountain Cancer Centers, a longtime user of Experian Health’s services. When you’re in the loop about what’s covered and what's not, you’ll also be in better shape to increase your revenue and cash flow. RMCC, for instance, reduced its denial rate to 27 percent in its first year using the service and has reached a $1 million ROI on the investment year over year. Payer Alerts isn’t some app that bombards you with pointless notifications every five seconds. By giving you the necessary information to make timely, strategic decisions, the software can help you start running your practice more like a lucrative business. Building the perfect defense Payer Alerts helps healthcare organizations streamline their workflow and maximize revenue through more than just its immediate features; its compatibility with other Experian Health services can provide the perfect defense against the myriad payer issues that might arise. Combining Payer Alerts with our Contract Manager and Contract Analysis solutions not only keeps you up-to-date with policy and procedure changes, but it also helps you target those changes in ways that meet your unique needs. When RMCC realized that sending out individual forms for different information was wasting time, it used its Experian Health software package to aggregate all the data from those separate appeals into a single form. This helped the company reach its efficiency improvement objectives, satisfying both patients and staff. Ultimately, you can’t fix any issues with your insurance processing if you don’t know they exist, and you won’t even know there’s an issue if you aren’t aware of the constant policy changes in the industry. While you can’t stop these changes from occurring, you can invest in a system to adapt to them and avoid the agony of having to scrutinize it all yourself. If you're ready to learn more about Experian Health's Payer Alerts, get in touch with us today. To learn more about how RMCC used Payer Alerts to increase revenue and cash flow, download the case study.

Published: September 18, 2018 by Experian Health

The world of healthcare, as everyone knows, can be complex. And in such a complicated system, solutions that simplify, automate, and reduce busywork can make a real difference in both patient satisfaction and workplace efficiency. Although healthcare is, by its nature, a high-touch field, there are several opportunities to allow automated software solutions to handle the basic processing tasks associated with patient management. When routine interactions with patients are automated, medical and administrative staff members can devote more of their time to the cases that need the most attention. Automated workflow solutions also simplify and reduce busywork to make a noticeable difference in patient satisfaction and workplace efficiency. Obviously, that outcome is desirable for all parties involved. It reduces costs, improves morale, and results in satisfied patients. In an ideal workflow environment, employees can personally attend to problem cases and resolve certain issues manually while an automated system handles the run-of-the-mill cases that cause administrative backlogs. Experian Health has worked hard to develop just such a system. We call it eCare NEXT®. Introducing eCare NEXT The eCare NEXT platform, using an approach called Touchless Processing™, is able to offload a number of key patient processes, including scheduling, preregistration, registration, and admissions. Touchless Processing is an exception-based system, meaning that it automatically flags patients who require manual follow-up with staffers. The system updates data in real time, and users can interact with it through either a work queue system or by responding to triggered alerts. Healthcare organizations using the system can automate up to 80 percent of human intervention in the patient management process — allowing healthcare staff to focus on larger, more important initiatives to improve the patient experience. And Touchless Processing doesn't just free up staff time; patients see immediate benefits as well. One of the biggest frustrations in a patient's experience is the inability to get a reliable estimate for how much a service will cost. The eCare NEXT system sorts through all the complex factors that affect healthcare pricing — which are often too complex for hospital billing departments to accurately estimate on their own — and quickly determines accurate cost estimates for both the patient and insurance. Efficiency results in lowered costs — and happier patients The eCare NEXT system cuts costs in other ways, too: by reducing staff training needs, by ensuring compliance, by enforcing transparency, and so on. The benefits of an automated patient management system can manifest themselves in all sorts of ways. Blessing Health System, based in Quincy, Illinois, implemented eCare NEXT and found that it reliably increased efficiency and accuracy in patient management: "Experian Health provided our staff with a reliable, real-time registration error-alerting process. Our overall registration accuracy rate has improved significantly since implementing eCare NEXT. We now have the tools we need to be successful in one user-friendly application." Blessing's employees found that eCare NEXT improved dashboard capabilities and made it easier to view critical data, including missed estimates and copays. It was a clear upgrade over Blessing's previous system, in which employees manually calculated patient estimates. After adopting eCare NEXT, Blessing's point of sale collections increased by over 80 percent, its clean claim rate increased from 63 percent to 90 percent, and denials went down by 27 percent. And because the process had become so much more accurate and efficient, the average number of days an account spent in accounts receivable decreased by 28 percent. There’s no need to labor under an outdated administrative system that's certain to cause backlogs, errors, and intense frustration for patients and staffers. By offloading patient management work to the eCare NEXT system, healthcare providers can do what they do best: help people. For more information, contact Experian Health or check out our Touchless Processing whitepaper.

Published: September 4, 2018 by Experian Health

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