Tag: Coverage Discovery

In this infographic, we break down the changes to post-COVID-19 patient journey, and the changes that have impacted every step.

Learn about COVID-19’s impact on the patient journey and see how digital transformation is helping the healthcare industry recover.

Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. Shots may be free to patients, but someone has to pay for them – and getting reimbursed is proving to be a major pain. Complicated billing processes, extra billing audits and mountains of extra paperwork, rejected claims and slow payments are not exclusive to pharmacies helping vaccinate America. With the coronavirus pandemic continuing to muddy the insurance landscape, getting hold of missing dollars is challenging. Healthcare reimbursements haven’t been straightforward for other providers either: widespread coverage loss and uncompensated care is putting extra strain on hospital revenue cycles. With the coronavirus pandemic continuing to muddy the insurance landscape, getting hold of missing dollars is challenging. Providers must find ways to quickly and accurately determine each patient’s coverage status to minimize bad debt. Navigating the complex world of post-COVID healthcare coverage What does the reimbursement landscape look like, one year on? After a long wait, elective procedures are back. But the surge in patient volumes means providers must be on their toes to keep track of coverage. The process for doing so must be streamlined and precise. Ramping up capacity to verify and check coverage without burdensome paperwork is a must. Patient intake is under pressure. More patients are coming through the doors as a result of elective services and vaccination programs (though not always to their usual facility). COVID-19 hasn’t gone away, and with pockets of infection spikes, safety remains a top priority. Capturing adequate insurance information in this context is no mean feat. Running automated coverage checks as soon as the patient arrives will minimize face-to-face contact during admissions and avoid delays. Patient access and collections staff are overburdened. Manual checks are difficult when staff are operating remotely or in a socially distanced environment, and patient information might be incomplete. Automated self-pay scrubbing can help handle the volume. A tool with built-in reporting can also offer insights on workflow and productivity, to help spot opportunities for quicker claims processing. New digital healthcare technologies aren’t always covered by insurers. Telehealth, a life raft during COVID-19, tends to be covered less often by private insurers, compared to Medicare and Medicaid. Coverage checks must factor this in to avoid errors and wasted time. Providers should opt for tools that sweep for payer updates to telehealth coverage to avoid unnecessary delays or denials. Employment levels may be inching upwards again, but tracking coverage remains a challenge as patients start new jobs with new health plans. In addition, checking for Medicare coverage in the midst of changing codes and protocols is time consuming and confusing. A third-party resource such as Coverage Discovery can look for all coverage options and make sure the right bill goes to the right payer. Find missing dollars with Coverage Discovery Hospitals, pharmacists and other healthcare providers can’t afford to continue losing money at a time when every dollar is needed to prepare for “after COVID-19.” Experian Health’s Coverage Discovery is a proven system for tracking down missing coverage quickly and easily, to avoid unnecessary revenue loss. Using billions of data assets and intelligent confidence scoring, it combs through multiple government and commercial payer accounts to maximize actionable coverage. Staff can trust the outputs and focus their attention where it’s really needed. By making coverage identification more efficient and accurate, it’s a shot in the arm for providers in need of faster reimbursements. Contact us to see how Coverage Discovery can be easily integrated into your revenue cycle, so you can maximize reimbursements over the coming weeks and months.

Learn how Coverage Discovery optimizes insurance verification for COVID-19 vaccinations, ensuring faster reimbursements for providers.

If President Biden’s two trillion-dollar stimulus package is approved by Congress, support will include funding for a national vaccination program. While the arrival of the vaccine is an immense relief, the logistics for rolling it out across the country present a major challenge. Even at a rate of one million shots administered per day, it could still take 18 months to vaccinate 80% of the population. There are numerous supply, distribution and communication challenges to overcome, both at national and state levels. And for individual healthcare providers, mass vaccine administration calls for a holistic approach, to make sure the right patients get the right dose at the right time and place. Could data analytics and digital automation tools be the key to identifying, engaging and supporting patients as the vaccine program is rolled out? Here are 6 ways digital technology could help your organization improve vaccine management. 6 digital tools to include in your vaccine management plan Segment patient groups with consumer data Deciding who gets the vaccine first is only hurdle number one. Providers must then segment patient populations according to risk categories (such as age or occupation), so they know who should be at the top of the list. Without accurate consumer data, there’s a risk that some vulnerable patients will be missed out. The answer lies in data analytics. By synthesizing thousands of data points for more than 300 million Americans, ConsumerView gives providers the detailed insights needed to segment and target patient populations. At the tap of a button, providers can find out which patients are essential workers or in high-risk groups, so they can be channeled into the vaccine program without delay.  Improve patient access and engagement with data insights According to the Kaiser Family Foundation, six in ten older adults say they don’t know when and where to get the vaccine. Many patients also face access barriers such as lack of transportation or childcare, or poor digital literacy. If providers don’t account for these in their outreach and engagement efforts, their vaccine program will fall flat. Consumer data can again help providers understand who their patients are, to identify those who might have trouble getting the vaccine. Insights on the social determinants of health can point to the best communication channels and support services to offer.  Keep track of patient identities with secure patient portals If providers are reaching out to patients and encouraging them to schedule vaccine appointments through their patient portal, they must have confidence that the person signing up and logging in is who they say they are. The right security protocols can help validate and protect patient information. One example of identity proofing technology is Precise ID®, which uses knowledge-based authentication (questions only the real person would be able to answer) and device recognition to verify patient identities. Prompt patients to book a vaccine appointment with automated outreach Imagine if patients could receive a text or voice message notifying them that it’s time to schedule their vaccine, with a link and simple instructions on how to book. With automated outreach, providers can proactively text or call a segment of patients with self-scheduling options and specific messages about the vaccine and its safety. Not only will this help to increase vaccination rates, it’ll reduce call center volumes at a time when staff are already under pressure. Make it easy for patients to schedule appointments with online self-scheduling In order to meet daily goals for vaccine administration, it has to be easy for patients to book appointments. The last thing any provider wants is no-shows. By deploying scheduling software that ties vaccination qualification rules into the booking process, providers can match patients to a convenient slot, ensure they meet the correct segmentation criteria prior to booking, and confirm whether the appointment is for the first or second dose. And of course, an online self-service scheduling tool such as Patient Schedule allows this part of the patient journey to be completed with minimal face-to-face contact, minimizing risk of infection. Speed up reimbursement with automated coverage discovery Finally, providers must make sure that vaccine-related reimbursements run smoothly. CMS has ruled that every American should have access to the vaccine without incurring any out-of-pocket costs. But although the government may be footing the final bill, providers still need to seek reimbursement by payers, which means they still need a reliable way to check a patient’s coverage status. With Coverage Discovery, providers can run quick, comprehensive checks of commercial and government coverage, and identify the right payer for administrative services. Digital software and analytics can provide efficient, secure and convenient ways for providers to guide patients through the vaccine management process, without delay. Contact us for more information on how Experian Health can support your organization to deliver a vaccine management plan.

for our upcoming webinar with Banner Health, where attendees will gain insights into the organization's workflow and processes.  It is estimated that 30-50% of denied claims occur on the front end during the patient access process, namely during registration, authorization and eligibility. Unfortunately, manual patient intake processes contribute to these denials, and ultimately, the bottom line, staff productivity and the patient experience take the hit. Banner Health chose to automate its patient access processes with eCare NEXT from Experian Health. The solution, which integrates directly with Banner Health’s acute and ambulatory electronic health records (EHRs), automates the organization’s preregistration workflow, including medical necessity and financial clearance. This improves registration accuracy, provides more accurate patient estimates and reduces the number of denials on the front end. Banner Health has benefited by incorporating a mix of Experian Health products that integrate directly and collaborate with other technologies and workflows already in place: Decrease in eligibility errors. With eCare NEXT, initial denials due to eligibility errors have been reduced by $30M in the first quarter alone since going live with Experian Health. Significant cost savings. With more accurate estimates, Banner Health has seen significant cost savings on the front end from more efficient coverage discovery. The system is consistently finding 30+% unique or new coverage in the patient access workflow. Improved staff engagement and satisfaction. Automation has greatly reduced manual inputs, enabling staff to focus more on the patient rather than systems and logins required for patient intake. Our partnership with Experian Health helps Banner Health's revenue cycle team deliver on its mission of “getting it right, at the right time, every time."  — Becky Peters, Executive Director of Patient Access Services, Banner Health  

Despite the majority of elective procedures being up and running again, patients are still keeping their distance. Nearly half of Americans say they or a family member have delayed care since the beginning of the pandemic, while visits to the emergency room and calls to 911 have dropped significantly. Patients are avoiding care, but it’s not for the reason you’d expect. Beyond obvious worries about catching and spreading the virus, a second concern is becoming apparent: patients are fearful of the potential cost of medical care. With so many furloughed, laid off or losing their insurance coverage, medical care has become unaffordable for millions of Americans. It’s especially tough for those who fall into the coverage gap, where their income is too high to grant access to Medicaid coverage, but too low to be caught by the ACA safety net. If patients continue to delay care, it’s only a matter of time before their symptoms worsen, leading to more complex and expensive treatment or even risking their lives. For the hospitals and health systems with revenue levels at a record low, encouraging patients to return for routine care is a matter for their own financial survival too. The answer lies in making sure patients feel safe and comfortable both when they come in for care, and when they look at their financial responsibilities. 5 ways to ease the return to routine care 1. Reassure patients about safety measures before and during their visit Patients are understandably anxious about what their visit is going to be like. Will they have their temperature taken? What should they do if they have symptoms of the virus? Will seating areas be spaced out and sanitized? Pre-visit communications and proactive information on arrival will help them feel comfortable and eliminate the shock factor of seeing more stringent infection control measures. 2. Minimize unnecessary contact by shifting patient intake online From online scheduling and pre-registration to telehealth and contactless payment, there are many ways to keep face-to-face interactions to a minimum. Not only will this help reduce the spread of the virus, it’ll make the whole patient experience more convenient for patients. Exploring a virtual and automated patient intake experience can also free up staff to work on other tasks, thus also protecting the organization’s bottom line through efficiency savings. 3. Encourage patients back to care with automated outreach campaigns With so much uncertainty at the moment, patients may be unsure if it’s even appropriate to come in for routine care. Use automated outreach to prompt them to book appointments and schedule follow up care. A digital scheduling platform can help you set up text-based outreach campaigns, to reassure patients that it’s safe (and essential!) to come in for any overdue care – without placing any undue burden on your call center. 4. Provide price transparency before and at the point of service With healthcare experts pointing to financial worries as a major barrier to care, anything providers can do to improve the patient financial experience is an advantage. Price transparency is the first step. When patients have clear and accessible payment estimates upfront, they can plan accordingly and/or seek financial assistance as quickly as possible, reducing the risk of non-payment. 5. Screen for charity care eligibility with faster automated checks Once those payment estimates have been generated, the next step is to confirm whether the patient is eligible for financial support, in the event that they’re unable to cover their bill. Checking eligibility for charity assistance is a time-suck for patient collections teams, but with access to the right datasets, it’s a perfect candidate for automation. These steps become even more urgent as providers face the prospect of a ‘twindemic’ – or a surge in COVID-19 cases colliding with flu season. By avoiding delays to care, patients can avoid the need for more serious and expensive treatment further down the line, when hospitals are likely to be under even greater pressures. Contact us to find out more about how our data-driven, automated patient intake solutions can help make your patients feel as safe and comfortable as possible, both physically and financially.

With many hospitals already operating at slim margins amidst the COVID-19 pandemic, the consequences of a rise in uncompensated care could be significant.

Finding missing coverage is a challenge for most healthcare providers, but with the right discovery strategy, it’s possible reduce bad debt.