Uncertainty over the future direction of the U.S. healthcare system has left a high percentage of patients uninsured or underinsured. These patients rely more heavily on price estimates for care and self-payment options, and this places a heavy burden on healthcare organizations to collect patients’ payments more quickly.
In addition, healthcare reimbursements are increasingly based on value. Now, providers can be penalized for giving patients inaccurate cost estimates about medical care. These estimates are taken seriously because inefficient and unpredictable revenue cycle management (RCM) that stems from errors, late payments, and other factors can cost healthcare providers up to 65 percent of their revenue.
This raises a pressing question: How do you make a historically unpredictable revenue cycle less chaotic and more efficient? There are many factors to that answer, but most of them point to and lean on innovative, data-driven IT solutions, such as Experian Health’s suite of RCM tools.
How can healthcare providers better predict revenue cycles?
When revenue cycles are accurately predicted across the care continuum, patients can more easily pay the costs of their care, and healthcare providers can increase their collection rates. Coverages can also be identified that patients are unaware that they qualify for, helping them lower their out-of-pocket expenses and decrease healthcare providers’ risks of failing to collect payment.
For predictability to matter, however, a revenue cycle needs transparency in pricing, particularly in the cost estimates patients receive before treatment. Precise, trustworthy estimates make it easier for Experian Health’s technology to generate clean claims that won’t be denied due to inaccuracies. Reducing claims denials not only allows healthcare providers to be paid faster, but it also saves the time, costs, and lost revenue of having to resubmit them.
All of these factors can be challenging to address individually — and exponentially more demanding to do so all together. However, Experian Health’s goal is to relieve that weight by providing solutions designed to make predicting and managing revenue cycles a more efficient and profitable practice.
How Experian Health’s solutions increase revenue cycle predictability.
Boosting the ability to forecast a revenue cycle requires a variety of data-driven solutions. At Experian Health, our Eligibility, Coverage Discovery, Patient Estimates, and Claim Scrubber technologies are just a few of the many tools we provide to help.
1. Passport Eligibility
Eligibility is a verification tool that combines up-to-date eligibility and benefits data for individual patients to ensure the accuracy of their upfront estimates. In turn, patients can rest easier knowing their predicted healthcare costs are accurate and derived from recent data.Additionally, the eligibility tool matches patients with Medicaid coverage that they were previously unaware they qualified for. Reclassifying patients and submitting their claims with the appropriate information lightens their stress about payments and increases a healthcare provider’s chances of reimbursement. As a result, future revenue cycles become clearer.
2. Coverage Discovery
Even patients with existing insurance may be unclear about what their coverage entails or how their plans apply to specific medical treatments. With our automated Coverage Discovery solution, hidden coverages are uncovered and applied to claims to avoid costly, time-consuming claim denials. The tool analyzes data from Medicare, Medicaid, and commercial insurance policies to help ensure patients don’t pay more unnecessary costs. For instance, in 2016, Coverage Discovery uncovered a total of $1.8 billion in hidden coverages for more than 275 Experian Health clients. With a stronger understanding of what coverage applies to patients, healthcare providers will gain better forecasting knowledge of the pain points in patient pay, which increases revenue cycle predictability.
3. Patient Estimates
With the information collected by the Eligibility and Coverage Discovery tools, our Patient Estimates platform can provide highly accurate cost estimates upfront. The solution utilizes data from numerous sources and populates that data automatically for each estimate to avoid human error.
Patients who know what to expect about the costs of their treatment can make better, more informed decisions about their healthcare. They’re also more likely to pay bills they’ve carefully budgeted for instead of ones that are notably higher than the estimates they expected. By understanding this cost information in advance, both patients and healthcare providers reap benefits, making the revenue cycle run smoothly.
4. Claim Scrubber
Next to garnished healthcare reimbursements, denied claims are another expensive consequence of an inaccurate revenue cycle forecast. Up to 20 percent of claims are denied or require reprocessing because of inaccurate or erroneous information. Our Claim Scrubber solution eliminates such errors by autopopulating claims with data pooled from a variety of relevant sources.
Claim Scrubber reviews each prebilled claim line by line for inaccuracies and then applies extensive edits based on general, patient-specific, and payer-specific data. The digital scrubbing drastically reduces the time, lost revenue, and possible penalties associated with denied claims by boosting first-time acceptance rates. Overall, with the elimination of troublesome errors, this tool allows revenue cycles to be predicted with ease.
In addition to providing an enhanced patient experience, successfully predicting and managing revenue cycles are both vital for healthcare organizations to thrive. At Experian Health, we believe that strong RCM is fundamental to any lucrative healthcare organization that strives to provide the highest quality of care. With our comprehensive suite of healthcare IT solutions, the current stress of RCM can soon become your organization’s best asset.