Claims & Contract Management

  It’s almost time to say goodbye to Health Insurance Claim Numbers (HICNS). Earlier this year, the Centers for Medicare and Medicaid Services (CMS) began the process of removing HICNs from Medicare cards, replacing them with a new Medicare Beneficiary Identifier (MBI). From January 1, 2020, CMS will only consider claims bearing the patient’s MBI number. With 150 million numbers issued to active and archived beneficiaries, the scale of the change could have a major impact on providers and their billing processes. Here, we look at how healthcare organizations can ensure they’re as prepared as possible. Why change to a Medicare Beneficiary Identifier? The shift to MBIs is an effort to protect patient information and address the vulnerabilities that come with relying on Social Security Numbers (SSN) to verify patient identities. HICNs are tied to an individual’s (or their spouse’s) SSN, which, according to cybersecurity experts, is an increasingly lucrative route to stealing someone’s identity. In 2018, over 1200 data breaches were reported, with over 400 million records exposed. Of these, SSNs were the most commonly exposed piece of data across all industries, with the exception of the healthcare and medical sector (which is affected nevertheless, given the industry’s widespread use of SSNs). Once a fraudster has their hands on someone’s SSN, it’s all too easy for them to create a fake identity and wreak havoc on that person’s life. What’s more, criminals can currently use SSNs in this way to access medical services or drugs under someone else’s name. Medical fraud is thought to cost between $80 and $230 billion annually in the U.S. If SSNs are no longer a means of confirming medical identities, the emotional and financial costs of medical fraud can be avoided. So, while plans for funding a national patient identifier may have been stalled for now, the MBI represents a significant step forward to protect patients from identity theft, keeping their information safe and reduce the likelihood of medical fraud. What does the transition to MBIs mean for your organization? Like the implementation of ICD-10, this is a huge transition for CMS and providers alike. Most providers are already using both numbers to manage patient claims, with 76% of fee-for-service claims submitted using the MBI for the week ending July 5, 2019. You can continue using the HICN for Medicare transactions such as billing, confirming eligibility status and checking claim status until the end of this year, but after that, Medicare will deny claims that don’t include the MBI. There are some exceptions, but the general rule is that claims must be submitted with the MBI, no matter when the service was provided. How should providers prepare for the MBI transition? The lower your denial rate, the healthier your revenue cycle will be. To avoid unnecessary denials as a result of the MBI transition, providers should consider the following strategies to ensure a smooth transition: Check systems and procedures Your software systems, automated processes and patient-facing procedures should already have been adapted to accept MBIs. Ensure your staff have processes in place to check and add new MBIs for existing and current Medicare patients. Remember, you’ll need to continue tracking HICNs alongside the new MBIs for the lifecycle of current claims. Appeals will use whichever identifier was used to submit the original claim. Reach out to existing patients The MBI won’t affect Medicare benefits, but recipients should all have received their new number and will need to use it to access services. Make sure existing patients are aware of the change and encourage members to update their details via their patient portal. Remind them to bring their new Medicare card to future appointments. Obtain an MBI for new patients When new patients register with you, ask for the new MBI. If they don’t have it, you should be able to look it up using your Medicare Administrative Contractor’s (MAC) web portal. Train staff so they know what to ask, how to use the MBI and how to answer patients’ questions. Alternatively, for about the past year, when a claim has been submitted to Medicare with a HICN, Medicare has returned the MBI on the remittance (835 file). This is something that can be used to create crosswalks. Optimize for cleaner claims One major effect of the change is that your existing method for carrying out Medicare scrubs, where SSNs could be used to check for Medicare eligibility based on demographic information, will no longer be possible. Consider a solution such as Claim Scrubber and Registration Quality Assurance to improve the accuracy of Medicare eligibility information. Encourage good data protection hygiene This is a chance to review your data protection practices. Consider whether there are additional steps you could take to safeguard your patient data and prevent medical theft. Are you ready? Experian Health’s Coverage Discovery tool already contains many patient MBIs through its historical repository, which grows every day. This historical repository contains a dataset of MBIs, which will allow us to continue searching for and presenting Medicare coverage to our clients when the transition period ends. Are you ready for this change to take place? Let’s schedule some time to review your coverage solutions and see if we can help improve your collection process.

Managing the revenue cycle draws in considerable resources for healthcare organizations, even when it’s working as planned. The American Medical Association puts direct transaction costs and inefficiencies associated with the “claims management revenue cycle” at around 25-30% of overall healthcare spending. But when errors are made and claims end up being denied, providers could end up missing out on as much as   The total revenue leakage is probably higher, when you consider the opportunity cost of staff time spent sorting out denials. Among the most common reasons for denials are missing or incorrect billing information, non-covered charges for care, and absent authorizations. Thankfully, these are all issues that can be minimized with the right strategies and tools. By optimizing your revenue cycle from the outset so that claims are right first time, you can save hassle and expense later on. Here are 7 ways to proactively reduce claim denials in your health system. Figure out why claims are denied First things first. You need to understand where denials are occurring in your revenue cycle and why. You can determine the root cause of denials by analyzing data that’s already available to you alongside information on industry trends. A business intelligence tool can help you use advanced data analytics to find opportunities for improvement, and generate actionable insights that are focused on your specific KPIs. Once you know where the weak points are, you can get the ball rolling with solutions. Prioritize the big-impact fixes In all likelihood, most providers will have the opportunity to improve the claims process at several points in the revenue cycle. You can’t do everything at once, so identify the areas with the greatest potential impact on your hospital’s bottom line. Can denials be traced to a particular department, service line or physician? Has a certain payer changed their approach? Compare the cost of implementing processes to tighten up the weak points in the cycle with the amount of revenue likely to be recovered to ensure you get the biggest ROI for your efforts. Automate patient access for more accurate claims Up to half of denied claims occur early in the revenue cycle, during patient access and registration. Automating the patient access workflow with real-time data can create a more efficient and accurate process, linking front and back office staff with shared systems that minimize errors and staff time. Martin Luther King Community Hospital experienced these efficiencies first-hand, when they integrated eCare NEXT® within their existing Cerner® system. As a result, their registration process became more streamlined, enabling them to cut two to three minutes from more than half of their registrations. Ensure patient matching is as accurate as possible Incorrect patient matching is a major source of revenue leakage for many providers, with around a third of claims denied on the basis of inaccurate patient identification. When it costs $25 to rework a claim and around $1000 for each mismatched pair of records, that’s a lot of lost revenue. Resolve your patient identities with the most robust data sources, and not only will you reduce claim denials, you’ll also have a more complete picture of each patient, which in turn will give them a better patient experience. Streamline prior authorization checks A survey by the American Medical Association found that prior authorization checks created a substantial burden for providers, with physicians spending an average of nearly 15 hours per week dealing with related tasks. For patients, this process can lead to delayed or even abandoned treatment. Using automated software, you can check claims against payer rules for medical necessity, frequency, duplication and modifiers, so you can quickly spot any claims that may be denied and correct them before submission. Process claims effectively Once you’ve streamlined the front-end of the claims process, you should of course look for ways to improve efficiencies throughout the rest of the cycle and immediately before the claim is sent to the payer. In fact, providers are expected to invest up to  , as the need to crack down on denials grows. Submitting claims in the correct format is a common and frustrating challenge. Since each payer has different requirements and formatting preferences for claim forms, edits should be customized. A revenue cycle service provider can help you build these custom edits and check each claim line by line, so you can submit with confidence and avoid having to redo them later. Monitor and analyze your revenue cycle Regular analysis is essential to consistently improve denial rates. By monitoring your internal processes across a range of metrics, you can gain a holistic view of the entire revenue cycle to see where there are further opportunities to optimize performance and prevent denials. When you have confidence in the freshness and accuracy of your data – including patient access data, payer performance information and patient matching – you can make confident decisions about exactly what needs to happen to improve your claims denials. Learn more about how leveraging data-driven insights to tighten up your claims management systems and take proactive steps to find lost revenue.  

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.  

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.  

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.

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.

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.

The Vancouver Clinic was facing the same problems that all healthcare organizations grapple with: too many claims denials and too much bad debt. So, Paul Brown, the clinic's chief financial officer, turned to his background in manufacturing technology to see how his organization could find efficiencies. He used his experience and knowledge to inform his and the clinic's roadmap to implement change. The first step was looking at quality. In manufacturing, every step in the process is studied closely and tested to ensure absolute accuracy. Vancouver Clinic did the same. From a patient perspective, it wanted a seamless experience, including making appointments, reducing patient time at reception, ensuring labs were returned quickly, and making sure patients had quick access to any prescriptions they needed. Although the improvements Vancouver Clinic wanted to make originally were seen as a technology project, it quickly became evident that improving the process would also require training for staff and defining performance indicators. However, as technology played a key role, Paul reached out to Experian Health to implement some much-needed automation in the revenue cycle process. One big goal for the partnership was to improve revenue and collections, which is important as U.S. healthcare spending continues to skyrocket. Spending has reached $3.5 trillion, and Medicare bad debt adds up to more than $3.69 billion. Experts predict these numbers will continue to grow, and soon, the nation will spend close to 20 percent of the gross domestic product on healthcare alone. Vancouver Clinic was also grappling with these issues. It had higher-than-average claims denial rates, which cost the clinic $10.5 million each year. It also had higher-than-average bad debt of $3.5 million. The goal was to reduce that by 50 percent, and the numbers are going in the right direction. To get there, Vancouver Clinic took a multifaceted approach to implementing software solutions. One solution was Payer Alerts, which creates authorization updates that reduce errors and inconsistencies before claims are submitted. When they’re detected, the alert format is easy to read and understand so corrections can be made quickly. Other technology solutions included Eligibility, which simplifies the insurance verification process; Payment Safe®, which is an efficient and seamless way to process patient payments; and Claim Scrubber, which helps submit clean claims to payers and reduce claim denials. The results for Vancouver Clinic were quick and dramatic. Claims denial rates dropped more than 30 percent. The denial rate, which was around 14 percent, is now under nine percent. Vancouver Clinic also reduced bad debt through more efficient patient processing by ensuring the clinic has the right insurance and personal information on patients. By collaborating with Experian Health, Vancouver Clinic has turned things around and has already realized a reduction in claim denials and bad debts to save them $2.3 million. An additional benefit of implementing these software changes is the ability for patients to use the self-service portal for the clinic. It allows patients to get estimates for services, set up payment schedules, pay their bills, schedule appointments, and provide feedback to the health system. Giving patients the ability to take control of these tasks simplifies the process for everyone, reduces busywork for staff, and improves patient satisfaction. Another efficiency that was implemented for staff was revamping software work lists. By reducing the number of lists they had to manage, employees were able to streamline their work. In an effort to maintain and continue to improve efficiencies, several key performance indicators are monitored to ensure quality throughout every step of the process. In much the same way that manufacturing keeps an eye on each process along the way, Vancouver Clinic has sought to improve every detail to create a seamless experience for patients. Through its continued partnership with Experian Health, it is well on its way to getting there.

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.