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Promoting Payment Accuracy and Transparency in Healthcare #ExperianStories

Merideth Wilson

Patients ideally should know what they’re going to owe when they show up for an appointment – the last thing they need is a big financial surprise to add to the stress of their visit. Similarly, doctors, nurses, hospitals and all healthcare providers help people to stay healthy day in and day out. Providers should be able to go to sleep at night knowing that they’ll be fairly compensated for the work that they do.

However, making that happen isn’t easy. Behind the scenes, contracts, benefits and eligibility between medical groups, hospitals and insurance payers are fairly nuanced and complex. Clients benefit when it comes to how much a patient owes a hospital or medical group after treatment, rough estimates aren’t ideal – perfection is difficult/ create problems and issues.

Billing must have pinpoint accuracy and add nuance based on unique contract terms that all medical groups and hospitals sign with their employers and payers.

The details can actually be quite difficult to keep straight, and there is an extensive amount of variation in each contract’s rules. Experian Health works to make payment transparency the norm, so that patients know what to expect and healthcare providers are paid fairly, accurately and in a timely fashion.

I began working for Experian in 2004 but my interest in product development and research eventually led me to Experian Health. My team of more than 100 Experian employees painstakingly reviews contracts, patient eligibility, benefits information and historical claims to generate an accurate fee estimate for each patient’s medical visit.

Nuance/aiding are helping to work toward this. We utilize up-to-date technology that organizes all the information we find in an extensive database and review the claims on behalf of both our medical group clients and patients.

The biggest challenge for me and my team is anticipating both patients’ and hospitals’ future needs and innovation in the field. Any time healthcare policies are changed or reimbursement guidelines shift, it affects our clients and requires nimble thinking on our part. How do we ensure that our technology is as modern as possible and our team members stay current on the latest trends and news? I’m looking forward to seeing how we continue adapting in the future.

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