All posts by Kelly Nguyen

Two years after the No Surprises Act was signed into law, healthcare price transparency and billing remain trending topics in the healthcare world. Together with the CMS final rule on price transparency, new regulations aimed at helping consumers better understand and plan for healthcare expenses have the potential to reshape the patient experience. Patients, providers, and politicians share an interest in improving price transparency. But developing and implementing the necessary processes has proven to be a challenge for providers. Meanwhile, the regulatory landscape continues to evolve, creating new challenges and expectations across the board. Where does price transparency stand today? Experian Health caught up with Riley Matthews, Senior Product Manager at Experian Health, to talk about the future of patient estimates and healthcare price transparency. Q1: As regulations have taken effect, how are patient perceptions changing when it comes to price transparency? “Patients are definitely here for these mandates,” Matthews says. “Most consumers have had the challenge of going to a hospital for care and finding out the bill is not what they expected. Maybe they didn’t even know what services they were getting in advance, or what the price for those services would be.” Now that price estimates and online pricing information are increasingly available, the consumer mindset is changing. Armed with greater access to information, patients feel empowered: “It’s changing the marketplace,” says Matthews. “Until now, healthcare hasn't truly been a free market: Pricing information has been kept very close to the chest and, often, patients didn’t see pricing until services were about to be rendered. At that point, they didn’t have time to evaluate. Patients can now see what the price of a radiology visit is at different facilities and compare.” As price transparency gains traction, consumers can be more proactive about the cost of care and managing their financial responsibility. Q2: What are the incentives for providers to comply with regulations and provide greater price transparency? “If someone is buying a car, they can search multiple dealerships online and compare pricing. Now, because of these mandates, patients can do the same for knee surgery,” Matthews explains. “If providers and hospitals aren't complying—if they’re not giving patients tools to help them understand and meet their financial obligations—they’re taking a risk.” In a study from Experian and PYMNTS, six in 10 patients who paid out-of-pocket for healthcare costs and received either an inaccurate estimate or a surprise bill said they would switch providers for a better payment experience. Separately, the regulatory consequences for failing to meet mandated requirements could escalate if the industry fails to comply. “CMS is likely to do more audits to enforce these mandates,” says Matthews. “The mandates themselves aren’t necessarily changing, but the amount of financial impact to providers and hospitals who don't comply is increasing. Price transparency violation fines start at $300 per day for a breach in the mandate, but they can go up to $5,500 a day or just over $2 million per year.” Q3: Have regulations been effective at motivating providers to get up to speed on implementation? “Implementation is accelerating but it hasn’t been quick,” Matthews says. “Compliance is on everybody's list of priorities but bringing systems up to speed has been a challenge: Technology takes time. Experian Health offers two solutions to help providers meet the core mandate for the CMS final rule. The first is Patient Estimates, a self-service portal patients can use to generate price estimates, make payments, and more. “Our self-service payment estimates portal provides a searchable list of prices for 300 common services, so patients can go to their hospital’s website and get a quote or view pricing,” Matthews says. “We’ve checked the box on that part of the CMS rule.” To meet the second part of the CMS mandate, Experian Health is partnering with Cleverley + Associates to create a downloadable, machine-readable pricing file for providers that can be digested and used across the organization. “Because there’s no standardization, providers haven’t been sure how to build this file,” Matthews says. “Many don’t have the tools or capability to do it themselves. “Combined with our self-service patient estimates, our partnership with Cleverley means Experian now has a full end-to-end solution that can solve for price transparency,” says Matthews. “And now that clients have a solution they can purchase and use, we expect to see an acceleration in adoption and compliance.” Q4: How are price transparency regulations evolving? What’s ahead for 2023? Both the CMS price transparency rules and the No Surprises Act are already having an impact on patients, who can now expect to receive a cost estimate prior to treatment. New online tools are on the way to help them understand their upfront costs. “Both of these regulations are meant to ensure that—there’s no better way to describe it—there are no surprises when a patient gets their bill, especially in self-pay scenarios,” says Matthews. “We already see providers moving in this direction.” But there are changes ahead. “The No Surprises Act isn’t fully fleshed out,” Matthews says. “Additional rules are going into effect January 1, 2023, and the industry is waiting on future regulations for insured patients that haven’t even been seen yet. Existing regulations will continue to evolve.” States are enacting additional mandates as well. According to Matthews, New York, Florida, and Colorado have all started to refine or expand their state regulations. Mandates in Colorado, for example, will allow patients to get price comparisons or dispute charges in advance of service. Q5: What actions should providers be thinking about as we move into 2023? Providers need to find the strategy that best fits their organization: “If a provider lacks a solution for both parts of the CMS mandate, they may want to reach out to a partner who can help support both, like Experian Health and Cleverley,” Matthews advises. “And if providers already meet half the mandate—if they currently have a portal like ours where those services are listed but lack the machine-readable file—they can identify whether it makes sense to partner to meet that other half. Providers can consider their costs and risks in each area and identify what works best.” At the same time, providers and their partners need to keep the patient experience top of mind. Although patients welcome greater price transparency, offering up-front cost estimates and pricing tools are only half the equation. Patients may also need financial help in the form of easy online and mobile payment options, payment plans, or charity assistance. “Philosophically and culturally, patients have been conditioned to approach healthcare without focusing on price,” Matthews says. “If they need specialized care, their doctor refers them to a specialist and they go. They don't see who's in or out of network or research what the prices will be. This has been the accepted process for many patients, including me. But perceptions are changing, especially as high-deductible health plans have become common now. Patients are becoming a little bit more skeptical.” Price transparency has the potential to make patients better consumers by empowering them to take charge of their own healthcare and their financial well-being. “Regulations are giving providers greater responsibility for price transparency, but a change in the consumer mindset is creating an equally compelling need for improvement,” says Matthews. “The game is definitely changing.” Discover how Experian Health can help healthcare organizations comply with healthcare price transparency and create better patient experiences.

Hospitals continue to face a capacity crisis as COVID-19, flu and respiratory syncytial virus (RSV) converge. Staffing shortages in both clinical and administrative teams further constrain the delivery of optimal care, with consequences for patient satisfaction and provider cash flow. With this challenge still ongoing, providers must find ways to maximize operational efficiencies and maintain patient flow. Accelerating patient intake with automated patient registration is a good place to start. Too often, registration requires patients to spend hours in a waiting room, filling out forms on a clipboard and conjuring up insurance information and medical history details from memory. These clunky processes cause delays, errors and stress for both patients and staff. In the current climate, healthcare providers should leverage digital tools that allow patients to complete registration easily and efficiently before they come in. Pitfalls of paper-based patient intake During registration, patient access teams must put considerable effort into collecting and checking patient information, documenting medical history and medications, verifying insurance eligibility and making sure the patient knows the details of their appointment or referral. Often, these checks are completed manually, with patients filling out paperwork in person when they arrive. It’s a slow and tedious process for patients and staff, made worse when there aren’t enough staff available. Unfortunately, manual processes also open the door to errors, creating additional work for staff members. If a patient’s address is inputted incorrectly, they may not receive important communications about appointments or billing, causing delays and confusion further down the line. In The Digital Healthcare Gap, a report by Experian Health and PYMNTS, Experian Health President Tom Cox says the “waiting room experience” is a common pain point for patients: “Having to schedule appointments at exactly 8 a.m. when the office opens isn’t convenient or efficient. Filling out paperwork that one has completed several times as a prerequisite to seeing a care provider aggravates just about everyone. And finding out how much the doctor visit and treatment costs long after the visit is complete is an experience unique to healthcare.” It's not an ideal first impression for patients, and it only compounds the pressure on short-staffed teams. Accelerate patient intake with advanced registration In The Digital Healthcare Gap, one-third of patients surveyed said they filled out registration forms from home. Enabling patients to complete registration in advance can greatly speed up patient intake. Patients can fill out forms in their own homes, with all their medical details at hand. It’s a more comfortable experience for patients and saves staff time by reducing the risk of errors. Shifting registration out of the waiting room can also help protect patients and staff from infection. But these survey results suggest that many patients are still completing registration in person. Providers should consider offering faster alternative options to those that want them, especially as waiting rooms fill up. With Experian Health’s Registration Accelerator, patients can complete intake forms from their mobile devices, anywhere and anytime. Details can be pre-filled automatically to save time and reduce errors, resulting in an easier intake experience with fewer issues for staff to resolve. By reducing administrative overhead, self-service tools can help providers manage unpredictable patient numbers and avoid bottlenecks during busy times. Automated patient registration for a more streamlined patient experience The current crisis magnifies the need for automated patient intake solutions, but patient access is already evolving. More than 8 in 10 providers say their patients prefer an online registration experience, according to Experian Health’s State of Patient Access 2.0 survey. In another report, 6 in 10 patients said they’d switch providers to one that offers a patient portal. Providers must open their digital front door or risk losing patients to competitors. A seamless patient intake experience that integrates scheduling, registration and payment systems will make patients feel taken care of. With user-friendly interfaces, automated appointment reminders and pre-filled insurance information, Registration Accelerator offers patients the speed and convenience that today’s consumers have come to expect. Patients can initiate registration with one click, then upload photos of their driver’s license and insurance card. Optical character recognition technology captures the necessary identity and insurance details, so patients and staff don’t have to fill it out manually. Patients can check their details and confirm appointments before completing authorization and consent forms. They don’t have to spend a minute more on registration than necessary and are less likely to miss appointments, leading to faster care. Maximize operational efficiency with automated patient registration solutions Registration Accelerator integrates with other automated patient-facing intake tools, such as Patient Scheduling and Patient Financial Advisor, to create a frictionless experience. Giving patients more control is not only more satisfying and convenient for them, but it also helps drive efficiency – which is increasingly important as hospitals reach capacity. Using digital systems instead of manual processes also enables easier integration with other data management systems, such as electronic medical records, hospital information systems and eCare NEXT®. Data need only be added once, which reduces the burden on staff and helps to avoid errors arising from ineligible handwriting. In addition to having greater confidence in the integrity of their data, providers can also use patient intake software to generate performance reports, revealing further opportunities to improve efficiency. Providers can allocate staff to high-priority tasks and use customizable workflows to maintain operational standards. The impact on the bottom line can be significant. Automated registration solutions reduce administrative costs. But perhaps more importantly, they prevent delays in reimbursement by avoiding time-consuming errors and inefficiencies. In this way, faster registration leads to earlier care, with better outcomes for both patients and providers. Find out more about how Registration Accelerator can ease the pressure on providers by speeding up patient intake during the busy winter period.

Whether by necessity or choice, the way patients navigate the healthcare payments system has transformed over the last few years. Healthcare’s digital front door swung open during the pandemic, offering patients far greater choice and flexibility in their use of digital payment methods. New legislation around surprise billing and transparent pricing gave patients greater visibility into the cost of care, improving their ability to plan for their financial responsibility. Many individuals switched between health plans and became responsible for a greater percentage of their healthcare bills. And the economic downturn continues to exert pressure on patients’ ability to pay, causing concern to patients and providers alike. Patient payment software can help ease these challenges. In this context, providers looking to attract and retain loyal patients must ensure the patient payments experience aligns with these changing needs and expectations. Clear communication, straightforward billing procedures and seamless payment options are essential to make it easier for patients to pay and protect provider profits. Here are 5 ways the right patient payment software can create a more satisfying patient experience and accelerate collections. 1. Offer clear and transparent medical billing processes As deductibles, co-payments and co-insurance arrangements become more complex, calculating patient financial responsibility is more challenging. Patients may find it hard to gauge what their final bill will be, prompting some to delay payments or even forego care altogether. A study by Experian Health and PYMNTS found that 46% of patients had canceled care after receiving a high-cost estimate, while 19% had experienced financial distress after spending more than they could afford on healthcare. Accessible, easy-to-understand billing procedures give patients a sense of control and encourage engagement in the healthcare process. This starts with reliable price estimates. In fact, around 60% of patients who received inaccurate pricing estimates would consider switching providers. With digital tools such as Patient Payment Estimates, providers can generate accurate estimates and give patients a clear breakdown of their financial responsibility before they come in for care. They also have the option to make secure payments via their mobile device. At the same time, insurance coverage discovery tools can be used to verify the patient’s insurance coverage and check for any forgotten coverage, so they have a better idea of what payer(s) will cover. Not only does this make the billing process more transparent and manageable for patients (resulting in faster payments for providers), but it also helps providers comply with new price transparency regulations. 2. Deliver flexible patient payment options Experian Health’s State of Patient Access surveys confirmed that patients want choice and control when it comes to paying for care. Experian Health President Tom Cox notes that “digital-first consumers are digital-first patients.” They want to see the “Amazon experience” replicated in their healthcare payments experience: “I will tell you, for myself as a patient, I much prefer to pay before I get there. Or I’d like to pay when I leave so that I don’t have to get the bill. If I do get the bill, I want to be able to pay online. What I don’t want is to fill out the slip with a check — the worst — or my credit card information and mail it to someone.” Digital payment methods can help providers remove friction in the payment experience by giving patients 24/7, self-service payment options, with options to pay by credit card, mobile wallets, online portals and peer-to-peer services. Experian Health’s suite of Patient Payment Solutions gives patients the flexibility they crave while helping providers increase patient satisfaction and accelerate collections. 3. Prioritize a personalized financial experience Just as there’s no one-size-fits-all remedy when it comes to clinical care, financial options must be tailored for each patient. Some patients will be willing and able to pay their bills in full and be keen to do so pre-service so they can forget about billing and focus on their health. Some may need to spread out payments into manageable chunks. Others may have no means of paying and feel unsure about their options. Patient Financial Clearance gives providers the data they need to customize payment plans based on each patient’s individual financial circumstances. With PatientSimple, patients can manage their payment plan through a user-friendly self-service portal, which allows them to generate pricing estimates, update insurance information, store credit card details, apply for charity care, combine payments to different providers and schedule appointments. This personalized service helps providers avoid missed payments and reduces the risk of having to involve multiple collections agencies, as patients have more confidence in their capacity to meet their financial responsibility. 4. Reduce patients’ financial worries While the uninsured rate has dropped, there are still more than 27 million Americans without health coverage. More will potentially lose coverage when the COVID-19 public health emergency ends. But even those with coverage may still worry about being able to pay for their out-of-pocket costs. Coverage Discovery runs automated checks to scan for any missing or forgotten billable coverage. Accounting for all possible coverage often reduces the patient’s financial responsibility and the accompanying anxiety that comes with a higher medical bill. Automation can also be used to pull together information from a provider’s chargemaster, claims history, payer contracts and patient benefits to generate accurate good faith estimates of the patient’s financial responsibility, which can eliminate ambiguity and help a patient better prepare for what they may owe. Read the report from Experian Health and PYMNTS, The Healthcare Conundrum: The impact of unexpected patient costs on care. 5. Improve operational performance Automation and digital tools also support operational efficiencies. Time-consuming manual tasks can be reduced or eliminated, allowing staff to focus on activities that need a human eye, or to support patients who need more personal assistance. Automation also reduces the risk of error, which can lead to contested bills and more work for staff to resubmit denied claims. For example, Kootenai Health used Patient Financial Clearance to automate presumptive charity checks and streamline a clunky workflow. They observed an overall accuracy of 88% in assigning patients to the right financial assistance program, reducing the number of accounts written off to bad debt. Sixty hours of staff time were saved, which were re-directed to priority tasks, eliminating unnecessary paperwork and improving the patient experience. Similarly, self-service payments allow patients to pay quickly and easily with minimum interaction with their providers. Not only does this reduce the burden on staff, but it also improves the patient’s financial journey. Patient payment software can increase satisfaction and accelerate collections What’s clear in these examples is that patient payment software and automation lead to faster, more flexible, and friction-free payment experiences for patients, while increasing recovery rates and operational efficiencies for providers. Find out how Experian Health’s Patient Payment Solutions help healthcare organizations reinvent patient billing and collections to boost revenue and improve patient satisfaction.

Can greater clarity and providing patient estimates at the beginning of the patient's financial journey set the stage for better access to care and a smoother path to payment? Millions of Americans struggle to pay for healthcare. A 2022 survey conducted by West Health and Gallup found four in 10 Americans, or roughly 112 million people, are cost insecure or cost desperate when it comes to healthcare. The issue is not just affordability; it’s also anxiety. Patients who fear they won’t be able to cover their out-of-pocket healthcare expenses may postpone or avoid treatment. At a minimum, anticipated medical expenses are a source of stress, especially for the growing number of patients who have high-deductible health plans. Pre-treatment patient estimates can help alleviate the stress. By taking some of the mystery out of medical bills, accurate estimates help patients understand and plan for costs. By opening a dialogue about treatment costs early in the process, patient estimates pave the way for further discussions about insurance coverage, payment plans, charity help, and more. As inflation wreaks havoc with household finances and talk of recession turns up the volume on financial stress, patient estimates and other tools that ease the payment process offer a bit of welcome relief for patients. A better patient financial journey offers benefits to providers as well. For healthcare organizations that are thinking about adding or improving pre-treatment patient estimates, here are 4 key benefits to consider: 1. Patients are more likely to forgo care if they can’t see how much it will cost. According to Experian Health and PYMNTS data published in July 2022, nearly half of consumers who canceled appointments last year did so because they were concerned about costs. Their concerns were not unfounded: the same survey revealed that one in five respondents spent more on healthcare than they could afford. Especially in uncertain economic times, the ability to understand and plan for out-of-pocket medical expenses is critical to patients. A Commonwealth survey found that deductibles were equal to 5% or more of household income in some cases; out-of-pocket costs were equal to 10% of household income in others. Add in concerns about the rising cost of living and the prospect of lost jobs, and the anxiety level surrounding healthcare costs only intensifies. Patient Payment Estimates help alleviate patient fears by providing clear, easy-to-understand estimates prior to treatment. Armed with this information, patients can make clear-eyed decisions about their care and ask about payment options if they’re needed. 2. Price transparency regulation is helping to create a new competitive environment. The No Surprises Act and CMS price transparency final rule are bringing price transparency into focus for patients and providers alike. These regulations require providers to offer accurate estimates in advance of treatment and disclose their pricing for common procedures. Although these regulations continue to evolve and providers are still working toward full compliance, patients are beginning to see more access to pricing information and a greater likelihood of receiving pre-treatment estimates. That’s creating a new competitive environment—and new choices for patients who are contemplating care. “In this new world, patients have the ability to branch out and research their own options,” says Riley Matthews, Senior Product Manager at Experian Health. “Patients have the pricing information to make informed decisions about healthcare and can shop between different providers based on price.” As a result, patient perceptions around transparency and trust are changing: “If providers want patients to keep walking through the door, they need to provide tools to help patients understand their financial obligations and feel that they’re being treated honestly and fairly.” Price transparency may have an additional benefit. According to Experian Health’s State of Patient Access: 2021 survey, eight in ten providers believe price transparency correlates with patients being more likely to pay bills on time. By simplifying pricing and payments, providers literally make it easier to pay. 3. Patients who know out-of-pocket costs in advance are more satisfied with care. In a March 2022 survey from Experian Health and PYMNTS, 88% of patients who received pre-treatment estimates were satisfied with the care they received from their family doctor, compared to 78% of patients who did not get an advance notice of costs. “Our ideas about patient satisfaction and care are changing,” says Matthews. “Healthcare is about more than physical health: It also encompasses mental, emotional, and financial health, all of which are affected by the patient payment experience. When healthcare costs or confusion stand in the way of patients getting treatment, or when healthcare bills create real financial challenges and stress, a transparent and compassionate billing process can make a crucial difference.” 4. Providing clear and accurate patient estimates is the first step to a better payment experience. Helping patients anticipate their healthcare bills with pre-treatment estimates is only the beginning of the journey. The same patient-centered payment tools that make the healthcare billing and payment process easier for patients also make it easier for providers. PatientSimple, Experian Health’s secure online patient portal, lets patients generate price estimates, apply for charity care, set up payment plans, update insurance information, make payments to hospitals and physicians, and even schedule appointments. Patient Financial Advisor delivers personalized estimates and payment options using the patient’s mobile device. Estimates are based on real-time benefits information and the payer’s contracted rates and pricing. Giving patients access to a range of information, using channels they prefer, helps them navigate the process at their convenience. Collections Optimization Manager helps providers target their collections, so they can direct resources where they’re most likely to succeed. Altogether, digital solutions that help improve the payment experience for patients can also help optimize the payment process for providers by making cost and payment information easily accessible to patients. It also creates behind-the-scenes efficiencies that streamline billing and collections for providers. Providing patient estimates is just the start.  Improving the patient payment experience at every step is a win for both patients and providers. Patients need clear information about treatment costs, insurance, and payment options to proactively plan their treatment and finances. But when providers put the systems in place to improve the patient's financial journey, they benefit too, by making these processes easier and more efficient. An improved patient payment experience may also reduce the need for difficult conversations with patients who are surprised by their medical bills and unsure how to pay them. More information, upfront, sets the stage for a healthier process overall. Learn more about Patient Payment Estimates and the full suite of Experian Health solutions to bring your patient payment experience up to speed.

Hattiesburg Clinic is Mississippi’s largest multispecialty clinic with over 450 physicians serving 19 counties. Claims management, patient collections and payer contract management are handled by the clinic’s Financial Services Department, which includes around 70 staff members. Challenge Hattiesburg Clinic in Mississippi sought to improve financial performance in the wake of the COVID-19 pandemic by focusing on reducing claim denials. The Financial Services Department had been hit by staffing shortages, which affected financial results. A more efficient digital claims management solution would attract and retain a high-performing virtual team, while supporting the shift away from existing paper-based systems. To submit more clean claims the first time, the Department set specific goals to: meet or exceed Epic benchmarks for primary denials maintain accounts receivable (AR) days at 42 or less process secondary and tertiary claims without waiting for the primary electronic remittance advice (ERA) to be posted. Solution Already impressed with Experian Health’s Contract Manager and Eligibility solutions, the Department chose another Experian product, ClaimSource®, to help reduce denials. Loretta McLaughlin, Assistant Director of Financial Services, said she was confident ClaimSource was a good candidate for the clinic’s claims platform: “ClaimSource seemed like the right fit for the department’s goals. The platform’s ability to customize edits, along with the level of customer support available, really set the solution apart from the alternatives.” ClaimSource uses scalable automation to prioritize claims, payments and denials. This allows staff to use their time as efficiently as possible, by working on the highest-impact accounts first. Using customizable edits and extensive national and local payer edits, it checks each claim for inconsistencies before the claim is submitted. ERA data is automatically integrated into Epic so that staff can check a claim’s status quickly and easily. With real-time reporting, staff gets insights from across the entire claim lifecycle to improve performance. Outcome The ability to integrate customizable edits was a big advantage for the clinic. They now have over 90 custom edits that help eliminate time-consuming errors, reduce denials, and allow staff to focus on the right accounts. As a result, Hattiesburg Clinic has achieved a 6.1% primary denial rate, which exceeds the Epic Financial Pulse benchmark. Despite staffing shortages, they’ve been able to accelerate receivables. They’re also seeing accelerated cash flow, now they can pursue claims from secondary and tertiary payers without awaiting the outcome of primary claims adjudication. ClaimSource is also creating a better staff experience: the tool eliminates the need for claims to be printed, so staff can work from any location. Now, over 50% of the team work from home. Thanks to automated workflows, output has been consistent despite a reduced workforce. Being able to submit clean claims the first time has a positive impact on AR days as well as staff workload. Loretta McLaughlin says: “Through ClaimSource’s automation and level of quality work, we have had to do less manual intervention.” To build on this success, the team intends to explore further opportunities to use automation to improve productivity. Options include automatically generating patient estimates, automating bad debt and refund workflows, and allowing patients to verify insurance eligibility through their patient portals. Find out more about how ClaimSource helps hospitals, health systems and physician groups reduce denials, protect profits and increase productivity through automated and scalable claims management.

Hospital margins remain below pre-pandemic levels, leaving providers needing a revenue-boosting remedy. According to a recent report commissioned by the American Hospital Association, margins for 2022 may be down by 37% (at best) compared to before the pandemic, with expenses heading in the other direction. Could automated collections software offer some relief? Expenses are predicted to increase by nearly $135 billion over 2021, of which a significant slice is labor costs. At the same time, healthcare has a vacancy rate second only to the hospitality industry. Resource-saving solutions are essential to ease pressure on existing healthcare staff and maintain operational performance. Patient collections stand out as a ripe opportunity to use automation to improve efficiency, increase revenue and allow staff to make the best use of their time. By streamlining the billing and payments workflow, automation can facilitate faster payments, improve the patient experience and reduce the heavy lift on staff. How should providers leverage automated collections software to maximize the benefits and build a strong foundation for 2023? Automated collections software in practice: PatientDial One example of how automation can improve patient collections is PatientDial, Experian Health’s cloud-based dialing platform. Instead of relying on manual processes to call patients about outstanding balances, providers can use PatientDial to automate patient outreach with inbound interactive voice response (IVR) and data-driven outbound collection strategies, and take payments after hours. This offers three major benefits to providers: 1. Saves staff time and maximizes resources Making phone calls to patients is resource-intensive and time-consuming, especially when patients are increasingly hesitant to answer calls from unknown numbers. Alex Liao, Product Manager at Experian Health, says, “You have a significant portion of the population that won’t answer their phone, but you still have those that do. With a solution like PatientDial we can automate these contact attempts, so collectors don’t have to spend time dialing and leaving voicemail messages.” PatientDial offers inbound, outbound and blended call environments that can accommodate both live agent and messaging campaigns. In 2021, the automated dialer saved clients 900,000 labor hours, while automated voicemail saved more than 1.5 minutes per voicemail. Automation helps to streamline collection efforts and gives staff time to focus on accounts most likely to pay. To leverage this, PatientDial integrates seamlessly with Experian Health’s Collections Optimization Manager. This solution uses advanced data and analytics to segment accounts and routes them to the right collectors and agencies, further maximizing staff time. 2. Increases cash flow and new revenue opportunities The biggest advantage of automated collections software is expediting the payment process. Like many providers, Dayton Children’s Hospital faced difficulties growing in-house collections during the pandemic. Making patient calls was their most effective way of collecting payments, but it had become a lengthy and cumbersome process. After integrating PatientDial, staff was able to increase the number of calls per day from 50-60 to 600, resulting in a corresponding uptick in collections. New patient appointments increased by 70%, creating more opportunities to bring in additional revenue. Liao says, “One of the key takeaways here is that automated collections tools like PatientDial allow you to cast a larger net and maximize collections. The uptick in daily calls was a direct result of the ability to make automated contact attempts, leave messages, and connect those who answered the phone with a live agent standing by.” PatientDial helped clients collect over $50 million in 2021, collecting an average of $176 per transaction. 3. Improve patient engagement with automated collections software Jason Considine, Chief Commercial Officer at Experian Health, notes that it’s not just operational costs and staffing shortages that are giving providers cause for concern. He says, “Federal aid packages are being unwound and the country’s opening back up, so people are spending money on things they weren’t spending money on before. To compound that problem, we have inflation coming in at levels we haven’t seen in decades.” Pressure on household finances could cause patients to start missing healthcare payments. Any steps providers can take to make it easier for patients to understand, plan and manage their bills will pay off in the long term. Automated collections software such as PatientDial removes hurdles for patients so they’re more likely to pay and more satisfied with the process. “We have seen that when patients are provided with the right options, they typically do want to pay. But life gets in the way,” says Liao. “Having phone call reminders and self-pay options through a payment IVR helps increase collections by giving patients additional options that they can use when convenient for them.” PatientDial is just one tool in the box. When used alongside other patient-friendly digital tools, the results will be exponentially greater as the overall patient experience improves and further efficiencies are unlocked. For example, PaymentSafe® is a natural fit. This automates payment processing so patients can pay at any point in their healthcare journey. Every patient encounter becomes a collections opportunity. While financial forecasts may be daunting, there are opportunities to streamline and simplify patient collections to boost revenue and reduce expenses. Automated collections software punches above its weight by providing neat solutions that make better use of limited staff resources, improve patient engagement and boost revenue. Find out more about how PatientDial and other automated collections solutions can help healthcare organizations increase collections in 2023.

With 2023 just around the corner, healthcare executives are teasing out their strategic priorities for the next 12 months. Where should they be focusing their attention? Here are the top 3 healthcare predictions to watch in 2023 and the actions needed to help providers prepare. Prediction 1: AI and automation will continue to gain traction “The time is now for providers to get ready, prepare and implement these technologies.” - ­Jason Considine, Chief Commercial Officer at Experian Health Automation came to the forefront during the pandemic, enabling essential access to care and filling in gaps created by staffing shortages. By now, the use of remote and digital tools is pretty well-established. Automation is the norm, but there’s room to leverage these solutions for an even greater ROI. As Jason Considine says, investing in technology that makes it easier for providers to get paid will be a particularly effective use of digital tools. One such example is in the digitalization of healthcare claims. Healthcare claims management processes have typically relied on manual systems. These can be slow and error-prone, creating avoidable extra work for staff and friction for patients. In the State of Claims 2022, 78% of executives said their organization would be likely to replace their existing claims management solution if convinced something else can deliver better ROI. Eliminating inefficiencies and optimizing reimbursement would certainly check that box. Tools like Denials Workflow Manager, Enhanced Claim Status and ClaimSource® use automation and detailed analytics to improve claims management performance. More claims can be processed more accurately, resulting in fewer denials and faster reimbursement. With denials increasing by 10–15%, claims automation is likely to be a top priority for many providers in 2023. Prediction 2: Patients will increasingly choose providers that offer a user-friendly financial experience  “The immediate path to better billing and payment processes may escalate pressures on providers right now, but it will yield better financial outcomes in the future for patients.” - Victoria Dames, Vice President of Product Management at Experian Health The economic downturn has put pressure on providers and patients, which we can expect to last into 2023. Patients are concerned about healthcare costs, but they’ve also come to expect a more transparent and compassionate financial experience. Experian Health's top healthcare predictions finds that reliable pricing estimates, support to find the right payment plan, and convenient and flexible payment options will be table stakes in 2023. For providers, implementing digital payment options to meet these needs may be challenging, but it’s an investment that will yield positive long-term results. More than 6 in 10 patients who have received an unexpected bill or inaccurate estimate would switch healthcare providers for a better experience in future, placing transparent medical billing at the core of attraction and retention strategies. The medical billing software outsourcing market is already experiencing historic growth as providers respond to patient demand for a digital financial experience: the market’s value is expected to grow over the next decade, from $11.1 billion in 2021 to $55.6 billion in 2032. Experian Health leads the way when it comes to creating a patient-friendly billing and payment experience, with solutions such as Patient Financial Advisor and Patient Estimates. Giving patients greater control over their financial journey with upfront estimates and tailored payment plans makes it easier for them to prepare for payments. Prediction 3: Providers that fail to create a welcoming digital front door could be closing off revenue opportunities  “Deliver convenience. People are consumers before they are patients.” - Tom Cox, President at Experian Health Automation offers opportunities for optimization throughout the revenue cycle, but one of the most crucial points is in patient access. Making patient access easier is on the list of top healthcare predictions, and for good reason - a frictionless first impression can have a powerful lasting effect. What should this look like? Cox advises that providers should “anticipate the needs of digital-first customers.” Patients expect the same personalized service they are accustomed to in other sectors, with convenience, choice and control at the center. Administrative “relics” such as the traditional waiting room clipboards and repetitive forms must be minimized where possible. A report from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods. 61% of patients even said they’d consider changing healthcare providers to one that offers a patient portal. Online scheduling software and self-service registration makes it easy for patients to complete these tasks in advance. Providers can then round out a user-friendly patient experience with Patient Payment Solutions. This gives patients a choice of payment methods, leading to faster payments. Providers have realized that many patient access functions can be achieved more efficiently and cost-effectively using self-service and remote digital tools. By streamlining intake operations, organizations can make better use of staff time, reduce errors and increase productivity, while improving the patient experience simultaneously. As revenue cycle technology continues to develop in 2023 and beyond, providers need to ensure they are capitalizing on the latest software to improve their bottom line, deliver on patients’ service expectations, and keep pace with healthcare predictions. Learn more about Experian Health's revenue cycle management solutions and contact us to find out how these solutions can help healthcare organizations open their digital front door and prepare for 2023.

Consumers can order groceries or rent a car with just a few clicks, so paying for medical care often feels frustratingly complex in comparison. Bewildering pricing information and limited payment options leave patients with a poor impression of their healthcare experience, no matter how good their clinical care is. If patients are confused about what they owe and how to pay, they’ll end up missing payments and even delay care. Creating streamlined billing and payment processes and automating patient payments makes life easier for patients and providers, especially as they shoulder more healthcare costs. Here are 6 reasons why providers should consider automating patient payments with tools like PaymentSafe®, to increase patient satisfaction and accelerate collections. 1. Customized payment options One of the top reasons to automate patient payments is the ability to deliver a personalized experience to each patient. No two patients have the same financial situation, employment circumstances or desire to use digital technology. Why expect them to thrive with a one-size-fits-all billing and payment solution? Automated patient payment services draw on multiple sources of data to generate individualized insights at a scale, speed and level of detail that would be impossible manually. For example, Patient Payment Estimates produce instant, pre-service cost estimates based on the patient’s specific care requirements and coverage. It pulls in real-time payer rates and provider charges to make sure the patient has an accurate estimate from the start. By giving patients accurate, timely and relevant billing information and payment options, providers can increase collections earlier in the revenue cycle and meet patient expectations for a convenient consumer experience. 2. Reduced operational costs The longer a patient bill goes unpaid, the less likely it is to be recovered in full. Each additional billing cycle adds to the cost to collect. Staff must spend more time making outward collections calls, handling billing queries and issuing monthly billing statements. Automating patient payments eliminates much of this expensive extra work and reduces overall collections costs. Providers can automate manual tasks such as checking for charity eligibility or clearing up patient records, as well as, leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter. 3. Timelier patient payments The common denominator in these automated payment solutions is that they all help patients clear their balances sooner rather than later. Patients can move on with their lives without bills hanging over them, and providers will see a healthier bottom line. With convenient and compassionate tools, each patient encounter can be an opportunity to collect. For example, PaymentSafe® enables providers to accept secure payments anywhere, anytime, using eChecking, debit or credit card, cash, check and recurring billing, through a single, easy-to-use web tool. A connected healthcare collections ecosystem can deliver the data needed for pre- and point-of-service payments, including insurance verification, patient responsibility assessments, financing options, and payment methods. 4. Better balance management According to Experian Health and PYMNTS data published in July 2022, nearly half of consumers who canceled appointments last year did so because of cost concerns, while a fifth spent more on healthcare than they could afford. Making bills manageable with automatically generated payment plans will take a huge weight off their shoulders. And in another joint report, Experian Health and PYMNTS find that patients welcome more flexible ways to spread out the cost of care. Financial stability seems to influence whether patients embrace payment plans. Of those living paycheck-to-paycheck, patients who struggled to pay bills were twice as likely to use a payment plan than those who did not struggle to pay bills. However, lower-income patients may be underutilizing payment plans, as 9% had yet to pay the bill from their last visit. Manually setting up payment plans can be time-consuming and tricky to get right. Patient Financial Clearance automatically calculates the most appropriate and affordable payment plan for each patient, based on their individual financial situation. Those that are likely to be able to pay upfront can be encouraged to do so, otherwise, they can pay in more manageable chunks. Read the report: “Managing Healthcare Costs: How Patients are Using Payment Plans” 5. Reduce the risk of errors A significant downside to manually managed patient collection processes is that it’s all too easy to replicate errors. Patient information may be outdated, causing statements to be mailed to the wrong address. Active insurance may be undisclosed, leading to missed opportunities for reimbursement and higher patient bills. Inaccurate financial or employment data may prompt staff to chase accounts that have a very low chance of being paid. In short: errors are expensive. Automation solves these challenges. Coverage checks, pre-authorizations and eligibility verifications can be completed automatically, giving providers and patients greater confidence in billing breakdowns. Error-free billing means patients are more likely to pay their bills sooner, saving providers time and money across the entire revenue cycle. 6. Improve patient experience Ultimately, automation helps providers deliver a more streamlined, secure and satisfying patient experience. Experian Health’s State of Patient Access 2.0 survey found that more providers were offering alternative payment methods and upfront billing estimates to make payment easier for patients. They were also introducing payment options at the start of the patient journey, which gives patients control over how and when they pay, and minimizes the risk of late and missed payments. Patients feel empowered when they have more control over their healthcare spending; when they are unsure about what they owe or how they should pay, payments will take much longer. This is about more than prompt payments: 6 in 10 patients who received an unexpected bill or inaccurate estimate say they would switch healthcare providers for a better payment experience. Automating patient payments is table stakes These are just a few examples of the advantages of using automated payment services for patients. Patient demand for convenient and flexible digital payment methods is not going anywhere. Providers must keep pace or risk patient attrition later. Digital processes can make the collections team’s jobs easier and more satisfying and are viewed as a way to retain staff as managers continue to address the many challenges that remain from the pandemic and now, inflation and economic uncertainty. Experian Health’s suite of healthcare collections solutions is designed to be user-friendly to minimize training requirements, and collections consultants are on hand to support whenever needed. Tips to maximize the benefits of automating patient payments When choosing a patient payment solution, providers should look for ones that: use robust data sources offer tracking and reporting tools come with adequate training, support and service-level agreements deliver a seamless experience for patients in alignment with client product offerings. Collect payments anytime, anywhere, with Experian Health’s PaymentSafe®, the automated payment processing solution that helps you increase collections earlier in the revenue cycle and avoid bad debt.

Up to 15 million Americans may find themselves without healthcare insurance when the COVID-19 public health emergency (PHE) ends. The PHE has been renewed until January 11, 2023, and while further extensions haven’t been ruled out, the Centers for Medicare and Medicaid Services (CMS) has advised healthcare providers to prepare for a return to pre-pandemic rules. Looming uncertainty over coverage has consequences for both providers and patients. This article looks at what providers may expect as the PHE comes to an end, and specifically, how to proactively verify insurance eligibility to maintain cash flow and help patients navigate the changes. How will insurance coverage change when the PHE ends? Emergency legislation has required Medicaid and the Children’s Health Insurance Program to maintain continuous enrollment for the duration of the PHE. When the previous rules resume, states will have 14 months to process eligibility checks for Medicaid and CHIP enrollees. The US Department of Health and Human Services (HHS) estimates that around 8.2 million Medicaid enrollees will no longer be eligible for coverage. Another 6.8 million eligible individuals may lose coverage through “administrative churn.” Churn occurs when patients fail to provide annual confirmation of Medicaid eligibility. This can occur because of short-term changes in circumstances or because they don’t reply to or understand requests for information. Some patients will qualify for Marketplace tax credits under the Affordable Care Act and others may seek employer-sponsored coverage. But a large proportion may fall into the “coverage gap,” earning too much to be eligible for Medicaid, but too little to qualify for Marketplace credits. The Inflation Reduction Act of 2022 extends access to enhanced Marketplace provisions until 2025, which may bridge the gap for some. HHS lists a number of additional actions that may be taken at the state level to mitigate potential coverage loss. This includes the adoption of Medicaid expansion, outreach and engagement campaigns. It also includes investments in end-of-PHE preparedness, staffing capacity and in eligibility and renewal systems. What do these changes mean for providers? Providers must be proactive in managing the disruption that could occur when millions of patients lose or change coverage. If more patients are without coverage and unable to pay for services, this could lead to an increase in uncompensated care, which costs providers millions in lost revenue. The process of verifying insurance for those with coverage is likely to be more complex, which could also affect providers’ bottom lines. Changes can increase the risk of errors, which could lead to more claim denials. Longer verification checks may cause delays in patient registration and higher call volumes, creating extra work and stress for staff and a poor experience for patients. The end of the PHE may also affect access to vaccines and food benefits, both of which were expanded under the emergency legislation. These changes could lead to an influx in calls and queries which could compound pressure on staff. These staff pressures are a particular concern given ongoing hospital staff shortages. A possible surge in COVID-19 and flu hospitalizations over winter could ramp up the challenge even more. How can providers verify insurance eligibility? The process of verifying insurance eligibility and benefits involves confirming that: the patient’s insurance information is valid and current they’re eligible to have the services in question covered under their existing plan. A patient insurance ID card is useful, but it’s not enough to prove eligibility. Patient access staff will often check payer websites or call payers directly to verify coverage. This can be a time-consuming and laborious process. Some providers use clearinghouses to run these checks in batches. This can be more efficient than verifying each account in-house but usually takes time to receive confirmation. Another option is to deploy insurance verification software. Experian Health’s Insurance Eligibility Verification solution allows providers to confirm patient eligibility in real-time. The tool connects with over 890 payers to access up-to-date eligibility and benefits data. Responses from multiple payers are modified so registrars can view patient information in a consistent format. Staff gets notifications when edits or follow-ups are needed. The tool also checks self-pay patients against Medicaid databases, which will be invaluable when the PHE ends. Why are automated, real-time insurance checks so important? No one wants patient care to be delayed. By validating a patient’s coverage before the patient arrives, Insurance Eligibility Verification helps fast-track registration. Automated checks also ease the manual burden on staff and handle higher patient volumes more efficiently. This improves operational efficiency, increases cleaner claim submissions and accelerates reimbursement, creating a more satisfying patient experience. Patients will have a clearer idea of what they’ll owe at the time of service, leading to fewer payment delays. What else can providers do to close the gaps in health insurance coverage and verify insurance eligibility? Providers can streamline coverage checks by incorporating automated searches for any missing or forgotten active coverage. Coverage Discovery runs multiple checks throughout the patient journey, using proprietary data repositories, advanced search heuristics and matching algorithms to comb through government and commercial payers to find previously unknown insurance coverage. Fewer accounts end up going to bad debt or written off as charity. This maximizes reimbursement for providers, while reassuring patients who may have believed they were uninsured. A further step to ease the financial burden on patients and increase the likelihood of reimbursement is to combine these solutions with tools that give patients greater clarity about their healthcare bills. For example, Patient Payment Estimates offer patients clear and accurate estimates of their financial responsibility before they come in for care. Patient Financial Advisor provides personalized payment plans so patients can spread out payments in a way that works for them, together with easy payment methods. Find out more about how Insurance Eligibility Verification helps providers verify insurance eligibility, speed up eligibility checks, maximize reimbursements and ease pressure on patients and staff as the continuous enrollment provision unwinds.