Patient Access

Significant changes in health insurance coverage are delivering a good and bad news report for providers. The good news is the continuing decline in the number of uninsured Americans. As of January 2015, the current uninsured rate is at an historic low of 12.9%. Much of this decrease can be attributed to the Affordable Care Act (ACA), with 7.1 million people enrolled in a plan on the federal marketplace, as well as an estimated 2.4 million people who obtained insurance through state exchanges. Add to that young adults staying on their parents’ plans (3 million), another 10 million people who are covered through Medicaid and Children’s Health Insurance Plan (CHIP), job-based coverage and plans outside of the marketplace, and the picture should seem rosy. However, the bad news comes when these newly insured people begin using their benefits and are faced with deductibles, coinsurance and copays. Providers are seeing more patients with insurance coverage who find it challenging to handle these additional out-of-pocket expenses. Compounding the challenge is the increase in high-deductible health plans (HDHP) and/or health savings accounts. The number of people with HDHPs has risen from 19.2 percent in 2008 to 33.4 percent in 2014, as reported by the Centers for Disease Control and Prevention. Tackling the problem Healthcare providers not only have a mandate to provide care, most also are deeply committed to providing charity care when it is needed. However, in order to remain solvent, providers must protect their financial well-being by actively seeking reimbursement and payment when it is available and applicable. But, how can organizations strike the right balance? As a first step, having a system in place for assessment, enrollment and case management will not only help you maximize reimbursement by enrolling self-pay patients in Medicaid or qualifying them for internal charity care, it can also be used to document your facility’s charitable services. Key components to a well-orchestrated charity program include:  Screen for financial assistance using the most up-to-date qualification guidelines for Medicaid and other financial aid and charity programs. Ensures patients who are eligible for charity care, Medicaid and other assistance programs receive needed financial support. Determine a patient’s propensity to pay, so that you can evaluate payment risk, identify the most appropriate collection route and initiate targeted financial counseling discussions. Organizations can then maximize reimbursement dollars from Medicaid and other financial assistance programs and reduce uncompensated care and bad debt write-offs. Verify patient identity to reduce fraud risk, claims denials and the rate of returned mail – expediting reimbursement. This process streamlines the financial assistance screening and enrollment process to increase staff productivity as well as patient satisfaction. Through these strategies, organizations can more effectively identify patients eligible for charity, combatting ongoing patient financial responsibility challenges – or the bad news – while still capitalizing on the good news of more patients receiving coverage. Learn more about charity care initiatives by registering for our upcoming webinar, “Financial Screening in the age of the Affordable Care Act,” on March 11, featuring Brandon Burnett discussing Kaiser Permanente’s experience and initiatives and Kim Berg from Experian Health.

The evolution from paper to online medical records is an opportunity to engage patients more fully in their care while making healthcare organizations more efficient. However, while patients enjoy the convenience of self-service access to all of their medical information, the portals offer cybercriminals a one-stop-shop for identity theft as well. According to Identity Theft Resource Center in San Diego, medical identity theft is the fastest growing type of identity theft, increasing at 32% annually. In fact, healthcare-related data breaches are already 10 times more frequent than data breaches in the financial services sector. And unlike stolen credit card information, which is often detected within a few transactions, medical identity theft often goes undetected for over a year. The comprehensive data contained in patient portals is especially lucrative to fraudsters, demanding a premium price in the underground market. While a stolen credit card number may sell for a dollar, a full set of medical records can command hundreds of dollars. The breadth of data within a patient portal offers fraudsters multiple opportunities to “cash in.” Compounding the problem is the level of detail presented on patient portals, often including unmasked insurance IDs, full images of patients’ insurance cards, problem lists, prescription histories. Stolen medical identities are used by criminals in two ways: obtaining medical care under the victim’s identity and using the identities to fraudulently bill for services or durable goods, which were never delivered. Problem lists, which are a mandated component of patient portals, are particularly useful to criminals, because they allow classification of each victim by the type of fraud which their identity could support. The problem lists typically use standard terminology, which makes them particularly useful for classification purposes. Using malicious software, criminals can search the lists for “key words” describing conditions that demand specific types of services or durable goods. This targeted approach would make fraud more personalized to the victim’s profile and harder to detect. Most patient portals use simple password protection, which can be easily captured by key-logging malware. This type of malware lays dormant on the victim’s machine, waiting for the victim to log into a patient portal site. When the patient logs in, the malware wakes up and captures the victim’s username and password. Using the stolen credentials, the criminals can get into the site, and once in can collect extensive information about the victim. Medical identity theft has severe consequences for both patients and providers. Patients are faced with the financial costs of covering fraudulent bills and medical costs stemming from treatment of other individuals. Comingling of the victim’s and the criminal’s medical records can also put the patient in life-threatening situations if treated or diagnosed incorrectly. Providers face steep financial costs from retribution payments and HIPAA violation fees up to $1.5M per violation, however arguably the most significant consequence they face is damage to reputation. Complicating matters is the fact that security measures cannot be so onerous that they dampen consumer adoption. Towards that end, use of covert technologies to analyze the identities and devices enrolling into a patient portal or logging in to it can increase security without impacting user experience. Precise ID® with FraudNet for healthcare portals provides healthcare organizations with a way to confidently authenticate patients and reduce risk during enrollment and ongoing access to healthcare portals. It does so in a streamlined manner without burdening patients with increased wait times and complexities. Together, these solutions identify fraud, authenticate patients and validate devices – all in a single platform. To learn more, view Experian Health’s complimentary on-demand webinar, “The Hidden Risks of Healthcare Portals,” or download the new white paper, “The Pitfalls of Healthcare Portals,” where we outline why your portal may be more vulnerable than you think.

There’s a unique dichotomy in healthcare that’s not found in other service industries. For example, when you go out to eat at a restaurant, you don’t expect the server to ask you to pay before the meal is served. Conversely, you also don’t expect to walk out of the restaurant after the meal without paying. However, if you have ever ordered the special of the day and been shocked when the check arrives and the item costs twice as much as other menu items, you can certainly understand the patient’s viewpoint. How can a patient make informed choices about his or her healthcare without knowing the cost? Price transparency – one of today’s hottest healthcare topics – offers significant benefits to both providers and patients, including: Empowering the patient to make well-informed decisions on healthcare treatments Improving patient satisfaction and involvement with their care management Allowing appropriate upfront collections based on realistic estimates Serving as a foundation for establishing payment plans or seeking charity The difficulty of providing a reliable estimate has hindered efforts to collect from patients at the point of service, when they are most likely to pay. In order for the estimate to be relevant and timely, it must bring together financial data from the chargemaster, claims history and payer contract terms, and integrate that with the patient’s insurance benefits. Thankfully, this is a task that is ideally suited to technology. Not only can you use a payment estimator to quickly and easily create a targeted estimate, healthcare organizations can also eliminate the need to manually update price lists, as well as remove guesswork and tedious searches through potentially outdated patient information. An estimator is the base of an effective upfront collections strategy, and is complemented by the ability to determine if a patient is eligible for charity care in addition to their propensity to pay. An additional complement is to streamline the payment process by facilitating the collection of patient open balances through eChecking, signature debit, credit, recurring billing, cash, check or money orders. The ability to create price transparency that is applicable to each patient’s individual situation is critical to a healthcare organization’s financial performance.

Meet Joe—a patient who is walking into a healthcare office, terrified of the news he might hear. He is confused and overwhelmed, not sure of where to turn for help. Joe isn’t entering a doctor’s exam room – he is actually walking into a hospital’s patient registration area, waiting to receive information about how much his procedure is going to cost. Although anxious about the procedure, Joe is even more concerned about its impact on the family budget, unsure of his insurance co-payment or what will be covered. He’s worried that he can’t afford to pay a large bill in one payment. His interactions with the registration staff over the next few minutes will set the stage for the remainder of his experience with the hospital. Now, let’s say the hospital realizes the value of having caring and compassionate financial conversations with patients at the start of the patient visit. Patient access staff quickly become the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. In this instance, leveraging a data-driven approach allows staff to verify Joe’s identity and insurance coverage as well as provide an accurate estimate of his payment responsibility. The staff even can review data to assess his ability to pay and evaluate various payment plan and/or financial assistance options. Even after Joe is discharged, the hospital continues to employ a patient-centered approach to collections, using patient financial data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. Joe’s financial data places his in the “most likely to pay” segment, indicating that he would not receive a payment follow up call until (for example) day 75 instead of the traditional call on day 45. This not only saves staff time and increases successful collections, it also preserves Joe’s satisfaction by eliminating unnecessary phone calls when he is likely to pay. Joe expected the hospital’s clinical staff to be responsive to his medical needs. When he found that the revenue cycle team was equally attentive to his financial needs, his satisfaction with the entire experience grew exponentially. It was fueled by a positive encounter that eased his mind about payment and allowed his to focus on his health. Using this proactive, personalized approach, the revenue cycle team had a major impact on both Joe’s experience and the bottom line. What is your healthcare organization doing to enhance the patient experience? Comment below to share some of your best practices.

Picture this: A movie trailer features a healthcare organization with a newly-minted portal through which patients access their private health information, make appointments and ask questions of their physician. The plot thickens as an unwelcomed guest looks for an identity to steal. With a few key strokes of a predictable password, the thief strikes gold, data is breached and the nightmare begins. From the patient standpoint, the Ponemon Institute® reports nearly 1.5 million Americans were affected by medical identity theft last year. And, those numbers are expected to rise as more hospitals add patient portals to comply with Meaningful Use Stage 2, which requires that more than 5% of all unique patients seen by the provider must be able to view, download, or transmit to a third party their health information. All this to say, organizations have the ability to proactively implement strategies to combat this concerning reality. To mitigate the risk of identity theft via a patient portal, healthcare organizations should consider a strategy to effectively control portal access beyond the basic user name and password. This type of heightened security via tools that combine state-of-the-art identity proofing, risk-based authentication and knowledge-based questions can help securely verify each patient’s identity. Such tools empower healthcare organizations to identify fraud more efficiently than traditional rules-based identity checks. Additionally, they provide the patient with a better online portal experience and greater peace of mind knowing that extra security measures are safeguarding their personal information. Don’t let a potential movie storyline dictate your reality. With industry experts predicting a 221 percent growth in the U.S. patient portal market by 2017, it’s time for healthcare organizations to partner with a trusted expert in fraud prevention to help them implement technologies that securely verify each patient’s identity. How secure is your patient portal?

There aren’t too many situations in which an individual purchases a product or service, but is NOT asked to pay for it right away. Healthcare, however, is somewhat unique in that regard, often avoiding a retail-based experience where patients receive service, but pay quite some time later, whether in full or the balance. Not surprisingly, this approach often times adversely impacts healthcare organizations in many ways. Best-case scenario, patient payments, while unpredictable, are received, but not in a timely manner and after a good deal of effort on the collections staff’s part. Worst-case scenario, the organization is left holding the proverbial bag, forced to write off bad debt, when payment could have been received if handled differently. In between, there are poor cash collections, increased revenue cycle costs and lower patient satisfaction. Organizations can avoid this perfect storm with a more precise approach to optimizing patient revenue. By leveraging tools that empower and improve upfront financial counseling communication, healthcare organizations stay one step ahead by accurately predicting patient responsibility payments and enhancing pre-service collections. When fueled by data and analytics, these tools offer a powerful two-pronged approach to minimizing risk and driving revenue: Avoid patient payment delays. Without knowing what insurance companies allow, many providers postpone collections until payer reimbursement is received. Healthcare organizations should instead have access to the latest contract terms, payment rules and fee schedules in order to identify patient and payer responsibility much earlier in the revenue cycle. Increase time-of-service collections. By proactively using patient payment data and current payer contract terms to calculate the amount owed by the patient at the time of service, organizations can effectively collect either a portion or all of that payment upfront. In the end, data-driven estimates of patient payment responsibility allow healthcare organizations to capture more revenue at the right time and boost cash flow. An added bonus is enhanced patient satisfaction because there are no confusing bills or ongoing collections calls, enabling a more personal experience for the patient. Hospitals have an opportunity to use data and analytics to improve the revenue stream and patient satisfaction. Learn about how Experian Healthcare Patient Responsibility Pricer can improve your collections on the front end of the revenue cycle and enhance the overall the patient experience.

We encounter gatekeepers every day, ranging from TSA agents at the airport and call-center operators for online retailers to office receptionists and hotel front desk staff. Gatekeepers have a tough job as they manage access, filter information, provide advice and maintain order. Their attitude and actions dramatically impact our experience as consumers. The healthcare industry must shift from a patient focus to a consumer focus — and it all starts with patient access. Patient access staff act as the frontline — the gatekeepers — as they gather critical patient information at the start of the patient visit and set the stage for the remainder of the encounter. They’re moving beyond simply performing routine registration tasks and collecting co-payments to engaging in a holistic approach to patient interactions. As a result, these critical staff members can create and facilitate compassionate financial discussions while handling revenue-related activities such as pre-service collections. It’s no small task, nor one that can be done without data and analytics. For example, staff can use tools driven by data and analytics to verify patient identity, which prevents fraud and identity theft and results in more accurate registration. Moreover, after reviewing insurance eligibility, patient access staff can leverage data and analytics to create accurate patient payment estimates, review data to assess a patient’s ability to pay and evaluate financial options. The bottom line impact creates a positive environment for financial discussions and improves collections on the front end, while reducing the likelihood of collections calls and bad debt on the back end. Patients benefit in that they gain a sense of confidence — and oftentimes relief — because they know where they stand financially and can focus their energy and attention on getting well. The time is right to establish patient access staff as gatekeepers of the patient experience by equipping them with knowledge and tools to empower them to improve the revenue stream and patient satisfaction.

Remember those commercials for the hamburger chain in the mid-1980’s? An elderly lady angrily shouted, “Where’s the beef?” in response to seeing a tiny burger on a large, fluffy bun. If that same creative concept were applied to healthcare today, perhaps the lady would proclaim, “Where’s the data?” when looking at the revenue cycle. While healthcare as a whole is moving toward using clinical data and analytics to enhance patient care, most organizations aren’t realizing the true potential of financial data to drive revenue cycle performance. So where does that potential lie? Quite simply, it lies in the vast amounts of financial data that healthcare organizations can access, yet do so ineffectively. By leveraging this existing data more appropriately, organizations can build and sustain margins while improving performance and enhancing the patient experience. Consider these three areas of opportunity to use data to drive the revenue cycle. Patient Access Correctly capturing and analyzing patient data at the initial point of contact allows an organization to reap large rewards, both clinically and financially. For example, correct patient identification reduces the risks of fraud and identity theft and ensures that medical records are being provided for the right patient, thus preserving patient safety. In addition, using data to provide accurate estimates of the patient’s payment responsibility up front and developing customized payment plans can elevate patient satisfaction as well as propensity to pay, allowing the healthcare organization to enhance collections and reduce bad debt. Claims and Contract Management Another area of opportunity is in payer contracts and claims. During contract negotiations, data and analytics help identify new service line opportunities for enhanced financial performance. Claims are more accurate and efficient when analytical tools review them before submission, comparing them with contract requirements and kicking out those with errors or ones that require further information. Consider the example of a healthcare organization that improved its recovery rate on denials by almost 50 percent by leveraging data to compare the amount received for the claim with the contracted amount. Collections Data and analytics also can be used to improve internal collections efficiency and profitability. Organizations can use data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. This allows collections staff to prioritize work based on a patient’s likelihood to pay, which improves both collections and the patient experience. For example, a patient scoring in the “most likely to pay” segment may not need a call until day 75, while someone in a lower segment may need additional calls and help setting up a payment plan within the first month. Segmenting in this way not only increases the likelihood of successful payment, it preserves patient satisfaction at the same time. Realize your revenue cycle’s true potential by leveraging financial information to enhance performance. Moreover, marry these activities with efforts to use clinical data to improve care, and you can realize a comprehensive approach to elevating overall quality and performance. You’ll no longer need to ask, “where’s the data?” Learn more about leveraging data and analytics to drive the revenue cycle with this white paper: The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance.

Americans who do not currently receive health insurance through their employers or a government program such as Medicaid or Medicare are now required to obtain insurance coverage or pay a penalty tax per the Affordable Care Act’s individual health insurance coverage mandate. These consumers can go to newly created health insurance exchanges (HIX) — offered through the state or federal government, depending on where an individual lives — to enroll in a private insurance plan. It’s definitely a patient-driven process. So, how can healthcare organizations help? They can take advantage of this opportunity to improve the patient experience by connecting patients with much-needed insurance, while simultaneously mitigating patient payment risk. Today’s patients want to be armed with as much information as possible. With this new initiative, healthcare providers can help patients navigate the various options offered through the exchanges by calculating how much patients might spend on insurance and by providing a comparison of plan benefits. However, it’s important for healthcare organizations to take this process a step further by screening patients to determine if they qualify for federal subsidies and beginning the enrollment process. Assisting patients in this way not only improves the patient experience, but also benefits the hospital by getting more patients enrolled with insurance, ultimately leading to higher reimbursement for services provided. That leads to the next likely question: how can healthcare organizations successfully aid in this process? Solutions powered by data and analytics are the key. By using a data-driven approach to HIX screening and enrollment, an organization can identify patients that meet the income criteria for subsidy payments and tax credits, and automate the enrollment process by prepopulating the state’s HIX application form. In much the same way that data is used to screen for various financial assistance programs such as Medicaid or charity care, HIX screening uses key information about a patient’s unique financial situation to accurately determine if the patient qualifies for subsidies to help them pay for their insurance. Interested in learning how you can improve the patient experience when it comes to insurance coverage? Check out our newest product, HIX Screening and Enrollment, and see how it can help support your patients as they begin to navigate the new aspects of healthcare reform.