Tag: Patient Collections

As retail and technology companies make moves in healthcare, existing providers must find new ways to attract and retain patients. Offering personalized patient payment plans is one way to meet evolving consumer demands and hold on to the competitive edge. The best part of this strategy? Providers can use data they already hold to deliver convenient and compassionate collections. Digital disruptors are driving a consumer-centric approach to healthcare payments Having transformed consumer expectations over the last decade, digital technology giants – along with a new generation of start-ups – are now actively pursuing a share of the multi-billion-dollar US healthcare market. Concierge medicine, on-demand virtual health and other personalized services are solidifying consumer expectations of flexibility, convenience and control. While consumers have more choice, they're also paying more for healthcare. Inflation-weary consumers are apprehensive about rising costs, and many report frustrations with healthcare billing and payment processes. According to a 2022 Gallup poll, nearly four in ten patients postponed medical care because of cost concerns. This tension between demand for choice and concerns about affordability leaves the sector vulnerable to disruption by players that offer alternative payment models that make healthcare more affordable for consumers, while making it easier to pay for care. Creating a more consumer-friendly approach to patient collections is essential for profitability. 1 in 10 patients use payment plans to manage the cost of care Research by Experian Health and PYMNTs shows that patients welcome payment plans to spread out the cost of care. One in ten patients had used a payment plan to pay for their most recent doctor's visit. Nearly three in ten older patients used a payment plan after receiving an unexpected bill. Unsurprisingly, those on lower incomes were most likely to need payment plans. Experian Health's State of Patient Access survey 2023 emphasized patients' desire for more flexible and transparent payment options, including pre-service estimates, payment plans and digital payment methods. Providers see the benefits too: around two-thirds of providers said their organization understands patients' unique financial situations and offers payment plans and financial assistance where appropriate. Using data to tailor patient payment plans For payment plans to work effectively, personalization is non-negotiable. Too often, payment plans apply a generic “one size fits all” formula to patient accounts, regardless of payment history, financial situation or other key indicators of the patient's ability to pay. This runs the risk of delivering a poor consumer experience while doing little to reduce patient bad debt. With a data-driven approach, healthcare organizations can identify the optimal plan for each patient. For example, PatientSimple® uses Experian Health's proprietary data and analytics to assess each patient's propensity to pay and guide them to the most appropriate financial pathway. A self-service portal gives patients a convenient way to generate estimates and consider different pricing plans, so they can make a more informed and confident decision about how to pay their bills. It also supports staff to have more compassionate financial conversations with patients. Similarly, Patient Financial Advisor and Patient Estimates give patients upfront, accurate estimates of what they're likely to owe, drawing on current chargemaster lists, payer contracts and the patient's insurance data. Together with payment plans, these estimates help patients avoid unexpected bills, so they have a more positive payment experience and are less likely to miss payments. A third tactic is to make it as easy as possible for patients to pay. Self-service and contactless payment options remove friction from the payment process, so patients are more inclined to pay promptly where they can. The patient's account data can be securely auto-populated into payment tools so they can pay and go with minimal fuss. Stay ahead of competitors by creating patient-friendly experiences As healthcare evolves, healthcare organizations need to develop strategies to remain competitive while still delivering compassionate care. Personalized patient payment plans are one way to strike that balance. Not only do they give patients the flexibility and convenience they’re looking for, but providers can also use existing data to tailor plans that benefit both company and customers alike. Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says these tools can help providers stay competitive as patients are exposed to a growing range of consumer-friendly healthcare services: “The move towards more patient friendly online experiences is a catalyst for improved price transparency. The challenge for providers is to adapt to shifting consumer needs while managing their resources wisely. But there's a major opportunity for providers to use data they already hold to help patients figure out the best financial pathway. Putting patients first is a sure-fire strategy to see patient satisfaction and patient collections rise in parallel.” Find out how healthcare organizations can remain profitable in an increasingly competitive market with personalized patient payment plans and patient payment solutions.

American consumers may be more optimistic about the state of the economy, but concerns about healthcare costs are always top-of-mind. A survey by Experian Health found that 40% of patients would cancel or postpone care if they were not informed of costs in advance. Planning for medical expenses can be a struggle for families facing rising costs and increasing deductibles. With profit margins under increasing pressure, providers must make constant improvements to patient collections processes to help patients navigate their financial obligations more easily. Finding new ways to maximize patient collections and increase efficiency while reducing friction in the patient experience is more important than ever. Technology and patient collections software offer a way to bridge the gap. This article looks at two case studies that involve leveraging automation and digital technology to create better patient collections processes. Case Study 1: how UCSDH improved patient collections with Collections Optimization Manager Patients are footing more of the bill for healthcare, leaving providers more exposed to each individuals' ability to pay. If patients are unable to pay in full and on time, providers will be left with growing ­– but avoidable – collections costs and an escalating risk of uncompensated care. Given that patients can have different financial circumstances, mailing out uniform statements and hoping they will be paid is a futile effort. Instead, providers should look for opportunities to proactively engage patients with personalized information, delivered earlier in the process. This can help maximize patient collections. One way to determine the most suitable collections strategy for each patient is to use data-driven software like Collections Optimization Manager. This tool helped the University of San Diego California Health (UCSDH) score and segment patients according to their propensity to pay so that each account was dealt with in the most appropriate way. For example, patients with a high likelihood of payment could be sent billing information automatically via inbound call campaigns, and offered self-service options to manage payments. Collections Optimization Manager also enabled UCSDH to automate the presumptive charity process, quickly identify patient accounts eligible for Medicaid or charity support, and direct them to the correct work queue to maximize workforce productivity. As a result, UCSDH increased collections by 250% in a single year, from $6 million to $21 million between 2019-20 and 2020-21. UCSDH also used Coverage Discovery® to track down active commercial and government coverage that patients were unaware of. More than $5 million was found in 2021 that would otherwise have been written off. For UCSDH, being able to provide a compassionate patient collections experience has been central to this success: “We serve our patients well when we can explain their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, System Director of Patient Revenue Cycle, UCSDH Case Study 2: how Kootenai Health streamlined eligibility checks with Patient Financial Clearance Another way to provide early clarity is to make sure patients aren't missing out on Medicaid assistance. However, this can be a time-consuming and labor-intensive exercise when attempted through manual processes. Because Kootenai Health needed a more streamlined workflow to screen patients for financial assistance, they implemented Patient Financial Clearance to assess and assign patients to the right pathways and programs, based on their specific circumstances. Patient Financial Clearance uses credit and non-credit data to identify patients missing out on Medicaid or charity assistance in real-time. It automates screening and document-gathering, reducing the manual burden on staff while improving the patient experience. Verifying Medicaid eligibility early prevents patient accounts from being sent down long and expensive collections pathways that would never result in payment. Kootenai's Financial Counseling manager reported that thanks to Patient Financial Clearance, “One of our patients with a $200,000 bill answered a few questions and was found eligible for Veterans benefits. With our previous vendor, we would have written the account off to charity.” In just 8 weeks, Patient Financial Clearance saved Kootenai 60 hours of staff time by automating the presumptive charity process and eliminating unnecessary applications. It also maintained an 88% accuracy in determining the right financial assistance program for the right patient. As Medicaid continuous enrollment under the COVID-19 public health emergency declaration comes to an end, uncertainty around eligibility is likely to increase. Taking steps to verify patients' status quickly and efficiently will be even more important. Bottom line: Maximize patient collections by making it easy to pay These are just two examples of how providers are using automation and digital technology to improve patient collection processes. In addition to screening and segmentation, providers can further tailor the financial experience by offering patients realistic payment plan options to make bills more manageable. Patients are provided with a range of convenient, self-service payment options to settle their bills according to their preferred method. Tools like Patient Financial Advisor allow patients to receive a text message with a link to a clear breakdown of their bill and the option to make a payment right from their mobile device. Find out more about how Experian Health's patient collections software and payment tools can help providers stop chasing the wrong accounts and deliver a proactive and personalized financial experience for patients.

According to Experian Health's State of Patient Access 2023 survey, providers think recent efforts to improve the patient financial experience are paying off. But do patients agree? The survey, carried out in December 2022, suggests a disconnect between how patients and providers view the patient collections process. Many providers rate their collections services favorably, having invested in pre-service estimates, flexible payment options and tailored payment plans. However, patients see room for improvement and a chance for providers to improve patient collections. Many say they feel anxious about managing medical expenses, with uncertainty prompting some to consider canceling care or switching providers. Could a more compassionate and personalized approach to healthcare billing help patients navigate their financial obligations more easily? Here are 4 ways providers can improve patient collections and create a patient experience that attracts long-term loyalty. 1. Provide proactive price transparency Patients want to know how much their care will cost before they receive it: almost 90% of patients said receiving a price estimate before care is essential. Providers recognize this, and 67% believe their organization is doing a good job of providing clear, understandable estimates prior to care. Unfortunately, only 29% of patients say they actually received one. Easing Digital Frictions in the Patient Journey, a collaborative survey of 2,333 consumers from Experian Health and PYMNTS, found that 82% of patients living paycheck to paycheck with issues paying their bills consider it “very” or “extremely” important to preview out-of-pocket costs before treatment. Among patients who received surprise bills, 40% spent more on healthcare than they could afford, compared with 18% of patients who did not receive surprise bills. Giving patients early clarity with precise pricing estimates helps them plan so they're less likely to avoid care or struggle with unexpected and unaffordable bills. Payments can also be collected faster and more efficiently. Despite the implementation of price transparency regulations, the incorporation of cost estimates into healthcare billing is not yet standardized, presenting a significant gap in the industry. Healthcare providers who prioritize accurate and easy-to-understand cost estimates are more likely to boost patient satisfaction ratings and increase improve patient collections. 2. Create personalized payment plans Personalized financial pathways are essential in healthcare. Patients have unique financial situations, and a one-size-fits-all approach won't suffice. Some patients may prefer to pay their bill upfront so they know it's taken care of, while others may need to spread out the cost into more manageable installments. Advanced data analytics can help providers create a more positive payment experience by assessing each individual's ability to pay and assigning them to the appropriate financial pathway. For example, Collections Optimization Manager scores and segments patients according to their propensity to pay, and automates the presumptive charity process so accounts are handled sensitively and efficiently. Using automation helped the University of California San Diego Health (UCSDH) deliver better patient experiences, maximize collections and reduce the cost to collect. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH's Systems Director explains that automation allowed them to maximize staff resources to support patients to understand their bills, as well as provided valuable insights into each patient's situation: “We serve our patients well when we can spend time explaining their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, explains how automation helped their organization optimize patient collections and improve patient satisfaction. 3. Provide support to those in need A topic on many providers' minds is Medicaid redetermination, following the loss of Medicaid coverage for millions of patients. Many may be eligible to re-apply, but in the short term, millions could be left floundering financially. Providers can support patients in this situation to sort through coverage, navigate charity eligibility and offer suitable payment plans to keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, says this is both a challenge and an opportunity for providers: “For providers, this may be a hard situation to navigate. At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offer them help can be powerful.” What can providers do as patients lose Medicaid coverage? The priority should be to identify patients who need charity assistance and connect them to any available support. Using credit data and other demographic data points, Patient Financial Clearance screens patients who may still be eligible for Medicaid and finds self-pay patients who may qualify for charity assistance. It also assigns patients to the appropriate pathways and even auto-enrolls them in financial assistance programs so they feel confident they're on the right path. 4. Offer flexible ways to pay Finally, a compassionate billing experience will involve as little friction as possible when the patient comes to making payments. According to the patients who participated in Experian Health's survey, payment experiences should be convenient, transparent and flexible, with 72% expressing a desire for online and mobile payment options. These features are essential to younger generations, who are less tolerant of inflexible, manual systems. Providers should offer a range of payment options that include in-person, telephone, mobile and online patient portals, so patients can pay in a way that's most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statements. Experian Health offers a suite of patient payment solutions that enable consumers to make secure payments at any point in their healthcare journey, through multiple channels. From customizable patient statements to mobile-enabled payment methods, these tools support a compassionate and convenient approach to patient billing, turning what can be a confusing process into one that is more efficient for both parties. Improve patient collections with automated solutions Consumers are the cornerstone of healthcare and providing a consumer-friendly payment experience can make a huge difference. Money is often a sensitive topic for patients, but with a consumer-centric payment experience, financial matters can be handled compassionately. Patients will be more satisfied and more likely to pay in full and on time, and providers can improve cash flow. With the right tools, healthcare billing and collections can become seamless and clear, and patients can pay their balances with ease. See how Collections Optimization Manager and other patient payment solutions can maximize and improve patient collections.

“We serve our patients well when we can spend time explaining their bills, what’s been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at University of California San Diego Health (UCSDH) Challenge University of California San Diego Health (UCSDH) is one of the top health systems in the United States, ranked number one in San Diego by US News and World Report. With more than 9,000 employees, it generates over $2 billion in net patient revenue each year. Patient collections are managed by the Shared Business Office (SBO), which handles all queries about billing, financial assistance and payment plans. Providing a best-in-class financial experience for patients is the SBO’s top priority. The team implemented a three-part strategy to improve the patient billing experience and increase collections, focusing on people, processes and technology. They saw opportunities to use automation to support this. Solution The SBO implemented Experian Health’s Collections Optimization Manager to improve collections and deliver an outstanding patient experience. Using in-depth data and advanced analytics, this tool scores and segments patients according to their propensity to pay and automates the presumptive charity process, so patient accounts are handled efficiently. This helps UCSDH reduce the cost to collect by maximizing staff and agency resources. To further reduce the risk of bad debt, the SBO uses Coverage Discovery® to find billable commercial and government coverage that was previously forgotten or unknown. Listen in as Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, discusses how their organization used automation to optimize patient collections and improve the patient experience. Outcome Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH also used segmentation data to improve outbound call campaigns. The team was able to create automated messages that can be sent to specific segments, so patients get the right information at the right time. By sending during time periods when patients were most likely to respond to calls, they were able to increase their collections rate. The screening feature also identified patient accounts that were eligible for Medicaid or charity support, deceased or bankrupt, and placed them in the correct work queue. The SBO leveraged Return Mail to run checks against patient addresses, to ensure that statements and refund checks were sent to the right place. Accounts with non-verified addresses were allocated to an auto-dialer for automated outreach. This helped reduce the manual labor required to find patient addresses, reduce bad debt and realize improved collections rates. By leveraging these tools, UCSDH has achieved: Increased collections from $6 million in 2019-2020 to $21 million in 2020-2021, a 250% increase Autodialer outcomes 2020-2022: 2,818 connects on return mail accounts 8% collections rate Return mail updates 2020-2022: 10,630 new and improved addresses found 55% hit rate Screening outcomes: 1,700+ deceased patient accounts identified between 2020-2022 2,700+ patient accounts associated with bankruptcy identified between 2020-2022 And thanks to Coverage Discovery, UCSDH has tracked down active insurance coverage amounting to more than $5 million in 2021. More than $4 million in coverage was found for patients under the California Medical Assistance Program. Had this coverage been missed, these amounts would have been written off as bad debt. Finding missing coverage outcomes:  $5M+ value of coverage found in 2021 19% hit rate in 2021-2022 (4% increase from the previous year) $4M+ value of Medi-Cal coverage found in 2021 9% hit rate in 2021-2022 for Medi-Cal scrubs Discover how Collections Optimization Manager and Coverage Discovery can help healthcare providers improve the patient billing experience while accelerating collections and reducing bad debt.

Healthcare providers that fail to embrace automation and digital tools to optimize patient collections could be leaving money on the table. Patient financial responsibility is higher than ever; however, the number of patients that struggle to pay is increasing, with 3 in 10 patients saying they’d be unable to pay a $500 bill and nearly a fifth of patients with medical debt believing they would never pay it off. As patient payments account for a growing portion of revenue, providers cannot afford to rely on subpar collections processes. Manual and paper-based patient collections remain the standard for many providers, but the reality is these outdated methods are unreliable and inefficient. Billing is slow and vulnerable to errors, and staff loses valuable time to the many pitfalls of paperwork. Optimizing patient collections with data-driven automation and user-friendly digital tools is a much smarter approach to accelerating payments, improving recovery rates and reducing operating costs. Why providers need to optimize patient collections Collecting patient payments has long been a pain point for providers. Recent changes sweeping across the insurance landscape and economy have exacerbated the challenge. More patients are turning to health plans with higher deductibles, which may seem more affordable in the short term, but leave patients footing a greater portion of their healthcare bills overall. At the same time, these bills – along with most other household expenses – are increasing at a rate that outpaces salary growth. For providers, this raises the risk of uncompensated care. Until recently, most write-offs in patient collections were associated with uninsured patients, but the uptick in high deductible health plans has nudged the burden of debt toward insured populations. Rather than waiting until the final bill has been determined and then mailing out a billing statement to the patient, providers must shift their focus to the earlier stages of the collection process. If they can calculate exactly how much each patient owes and route their account accordingly, collections will be smoother and faster. The task of calculating patient financial responsibility is complex, though. Applying automation technology to tackle this challenge is no longer optional. Benefits of automating patient collections The digital revolution accelerated during the early stages of the COVID-19 pandemic. Scheduling and registration – which lay the groundwork for efficient patient collections – were managed through remote online self-service tools, while contactless payments became commonplace. The drivers of data and automation may have shifted now, but the benefits remain clear. Aside from the financial savings associated with transitioning to fully electronic transactions, automation facilitates operational efficiencies. Automation can counter staffing shortages in patient collections teams, by helping staff focus on the accounts most likely to pay. They can filter out bankrupt or deceased accounts and use automation to check charity eligibility. Automated dialing and texting can be used for more efficient patient communications. Optimizing billing and payments can also create a more compassionate experience and make it easier for patients to understand what they owe and how to pay, without the need for endless phone calls to patient collections teams. Providers should consider the following five steps to leverage data and automation for improved patient collections: Step 1: Establish clear financial policies for patient collections Streamlined collections begin with clear patient communications. Patients should be advised of payment policies as early as possible. For example, does a particular type of appointment have to be paid for at the point of service? Could they be eligible for a discount if they pay a larger bill sooner? When patients are fully informed of their financial obligations, it’s easier for them to plan. Automated upfront Patient Payment Estimates give patients an accurate idea of what they’re likely to owe, reducing the risk of missed or delayed payments. Automated data analytics can help providers tailor patient communications based on the patient’s preferred method of communication and offer the most relevant information when it matters most. Step 2: Prioritize point-of-service payments to optimize patient collections The longer a bill sits in accounts receivable, the less likely it will be recovered in full. Encouraging patients to pay as much of the bill as possible, as early as possible, helps improve recovery rates. This starts with verifying the patient’s insurance coverage. Giving the patient clarity about their coverage, co-pays and deductibles at the time of service reduce payment delays and confusion. For the Director of Patient Financial Services at Kaiser Permanente Northern California, applying automation in this way has helped staff and patients navigate a more complex coverage environment and drive up point-of-service payments: “At Kaiser, we’ve implemented financial assistance patient identity verification tools to help us identify what our members would be able to pay at the point of service, and how we would manage them on the back end if they end up with a patient balance. Before we had these tools, we were blind as to what our patients would be able to pay.” Step 3: Give patients personalized payment options Offering a choice of payment methods that patients can access anytime, anywhere, can also increase point-of-service payments. Patients repeatedly say they want flexibility, having grown accustomed to the digital and contactless payment methods used in everyday retail scenarios. Experian Health’s Patient Payment Solutions enable providers to accept multiple forms of digital and contactless payments, including eChecking, credit and mobile payments. Patients also welcome the option to spread out payments and set up automatic recurring payments to manage larger balances. Providers can deliver a more satisfying patient experience and accelerate collections by offering personalized payment plans. Data and automation help providers identify and deliver the best-fit options for each patient. For example, PatientSimple is a consumer-friendly self-service portal that identifies the best financial pathway for each patient and allows them to pay balances with ease. It also stores payment information so patients don’t need to input their card details every time they want to pay. Step 4: Use smart strategies to pursue bad debt Determining the best collection approach for each patient requires current and comprehensive insights into their financial situation. Collections Optimization Manager pulls together data to help providers prioritize accounts by payment probability. Communications regarding accounts with a high payment probability can be automated and managed through self-service options. Accounts that are less likely to be paid can be routed to collections agencies or managed in-house, to increase workforce productivity. Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, explains how automated collections insights reduce bad debt: “We’re able to extract data from the accounts receivable file and produce robust analytics and insights. That allows us to screen or scrub out those accounts that we should not be scoring or segmenting. Then, we shift to the customized segmentation, which allows the client to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.” Step 5: Train staff to have compassionate conversations Finally, with the right data, staff can have more compassionate and useful conversations with patients about how best to manage bills. Medical debt is a growing concern for patients, and staff should be trained to handle these conversations sensitively. Providers can further maximize their collections strategy by training staff to use collections optimization software to its fullest potential. Staff may worry about the learning curve when transitioning from paper-based to digital processes. Experian Health’s Collections Optimization Manager is designed with a user-friendly interface for intuitive navigation. Staff can easily view reporting and benchmarking insights and identify opportunities to improve collection rates. Find the right revenue cycle management partner With support from a trusted revenue cycle management company, providers can improve patient payment collections for increased revenue and streamlined operations. Speak to Experian Health today to find out how our best-in-class solutions are helping healthcare providers optimize patient collections, reduce bad debt, boost recovery rates and deliver a stand-out patient financial experience.

According to the most recent figures from the Centers for Disease Control and Prevention, around 8.8% of Americans are without health insurance. While this has dipped since the pandemic high of 10.3% towards the end of 2020, it still leaves nearly 30 million people facing the often-difficult decision of what to do when they need healthcare. A further 40 million underinsured individuals could find themselves in the same position.  Do they pay for it themselves, avoid care altogether or seek financial assistance? With inflation on the rise and government pandemic support coming to an end, even those with coverage may need additional charity care support. Several regulatory efforts have been made to address healthcare affordability and increase transparency around charity care, particularly at the state level. For providers, the challenge is to find efficient ways to screen for charity care eligibility as more patients become eligible for support, and remain compliant as these new regulations come into effect. Why screen for presumptive charity? Eligibility for charity care depends on a hospital's financial assistance policy and relevant state regulations. Uninsured patients may be offered a full or partial discount on their medical bill, while insured patients may be awarded a discount on the cost of care. Without charity care, these unpaid bills would be tagged as bad debt, which could lead to patients being chased for payments they're unable to make and affect the provider's cash flow. To qualify for charity care, patients are often asked to share their household size and income, among other details. Often a provider will ask patients if they'd like to fill out financial assistance forms during patient intake, but many patients decline or are unable to provide the necessary information. Some may feel embarrassed about needing support or worry about how the information will be used. There may be language or literacy barriers. Some may assume they're not entitled to support and decline the forms. To get around this, providers use automated screening software to identify patients who may be eligible for charity care. This pulls together credit information, demographic data and financial details to determine whether the patient qualifies. Patients get the support – and thus the care – they need, and providers can focus their collections efforts on those who are most likely to be able to pay. Regulation 501(r) permits this type of presumptive screening by a reputable third party. What does the legislation say about charity care? As the use of presumptive eligibility screening has grown, several federal and state regulations have been introduced to encourage clarity, consistency and best practice. Providers must keep pace with changes to charity care policy or risk civil penalties or the loss of tax-exempt status. Under the Affordable Care Act, Regulation 501(r) requires hospitals that offer charity care to have a written financial assistance policy, specify maximum amounts that eligible patients can be charged, and determine a patient's eligibility before sending their bill to collections. Again, it allows for this process to be automated using a third-party vendor. Individual states also have their own requirements around eligibility screening, for example: In Washington, the legislature has recently voted to expand charity care eligibility as of July 1 2022 for patients who meet federal poverty level thresholds and have exhausted third-party coverage options. The new rules require hospitals to identify patients that might be eligible for retroactive Medicaid support and support them in applying for coverage. In California, the AB 1020 rule raises the income level for charity care eligibility to 400% of the federal poverty level. Hospitals must display online notices explaining their policy for financially qualified and self-pay patients. They must also wait 180 days before assigning unpaid patient bills to collections, and provide information to patients before doing so. AB 532 requires hospitals to give patients written details of patient charity care and discount policies at the time of service or at least before they are discharged. How can providers streamline the presumptive screening process? Automated presumptive screening can help providers comply with these new rules and implement their own financial assistance policies in the most efficient way. For example, Experian Health's Patient Financial Clearance uses current financial data to screen patients for Medicaid, charity care and other financial assistance programs in line with the provider's unique charity policies. It incorporates customizable logic that helps providers adhere to regulatory requirements and internal rules around charity care and billing. Screening happens automatically prior to or at the point of service, generating an estimated Federal Poverty Level (FPL) percentage for each guarantor.  A healthcare-based propensity to pay score can also be calculated, giving providers a further data point to work best with patients. This makes it easy for patient advocates to connect patients with the most appropriate financial assistance program, and even auto-enroll them. If the patient does have an amount to pay, they can be guided to the optimal payment plan for their individual circumstances. Patients can get direct access to screening qualification tools too, with solutions like Patient Financial Clearance. They can check their qualification status and upload documentation to qualify for discounted or free care via text to their mobile device. In addition to helping providers ensure regulatory compliance and document charitable services, this tool helps maximize collections and deliver a patient-centered financial experience. Providers should also check that their collections partners are aware of their obligations under charity care law, and ensure they're compliant, too. Keeping patients in the loop during charity care eligibility screening Clear communication is at the heart of a compassionate patient experience, fostering loyalty and trust. In the context of charity care screening, this means making sure that patients know that financial assistance may be available (now also a requirement under charity care regulations). In the past, some patients were not informed about how to apply for financial assistance and struggled with bills they couldn't afford. Others were assigned to charity care without their knowledge and spent months worrying unnecessarily about bills that would never arrive. Automated charity care checks solve both situations, by ensuring that no patient misses out on support to which they're entitled and by making it easy for providers to notify them. Patient Financial Clearance generates scripts for patient advocates to use during financial counseling discussions, to help patients navigate the financial process with greater ease. And with mobile text charity screening, the patient gets the information they need, right in the palm of their hand, so they can engage with the process more easily. Patient Outreach solutions can complement these activities by providing timely and personalized prompts and reminders through the patients' preferred communication channels. Not only will this enhance the patient experience and support compliance with charity screening rules, but it also helps improve patient outcomes by keeping patients on track with their care plans and driving down unnecessary readmissions. And for patients who do have an amount to pay, a payment experience that's tailored to their financial circumstances will further boost patient satisfaction and collections. The ROI on these tools can be significant. Let's say a hospital treats 1,460 uninsured patients per month. If just 10% of those patients qualify for Medicaid, at an average reimbursement rate of $1000, the hospital could claim $146,000 per month by ensuring those patients are enrolled – and avoid writing off nearly $1.8 million per year. As economic uncertainty continues to weigh on providers and patients alike, the pressure's on to streamline patient collections and prevent avoidable missteps such as non-compliance with charity care rules. Find out how using an automated financial assistance process with Patient Financial Clearance can create a safety net for providers and patients, increase collections and reduce bad debt as patient financial responsibility increases.

Dayton Children’s Hospital is a pediatric hospital in Ohio with over 300,000 annual patient visits. Ranked by U.S News & World Report as one of the top 50 pediatric facilities in the United States, the facility’s mission centers around providing “optimal health for every child.”  Challenges The Patient Accounts department, led by Richard Gonzales, wanted to reduce his team’s reliance on third-party collections agencies and avoid associated fees. This meant that his in-house team needed to further scale its operations and processes to reach their in-house collections goals. The Pre-Service Operations department, managed by Jason Schenck, pursued efficiencies for resources within the centralized scheduling team, including the goal to quickly respond to referrals and turning those referrals into scheduled appointments within 24 hours. Throughout the pandemic, both teams experienced staffing shortages and pandemic-related absences. Because their dialing methodologies were manual, these disruptions in personnel prohibited them from growing in-house collections and reaching the turnaround times Schenck's team wanted to achieve for scheduling referrals. As Dayton Children’s strived to achieve these ambitious goals, they decided to proactively provide a better patient experience through convenience, connection and an effective communication experience. Resolution Dayton Children’s launched Experian Health’s PatientDial solution in the Patient Accounts department to scale their in-house collections efforts, thereby reducing dependency on their outside collections agencies. The solution was also adopted in the Pre-Service Operations department to automate dialing and conversation readiness so that the team could expedite the scheduling of referred patients. The expertise of a dedicated Experian Health consultant provided unwavering support to the two departmental heads and also gave them full control over the operations to best match their expectations. Streamlining patient payment collections with PatientDial  The Patient Accounts department’s operations revolve around billing a claim, reducing bad debt, increasing patient collections and providing effective customer service. They devised a two-pronged approach when it came to contacting patients for payments. The outbound campaign focused on collections, whereas the inbound customer service team handled the large volume of incoming calls from customers and rerouted them to the correct department. When it comes to collections, the Patient Accounts department found that making phone calls was the most effective medium to support their collections efforts. Billing is a complex process and taking the time to connect with patient guarantors to explain those bills paid off. To refine the communication approach, patient accounts were segmented based on outstanding balance amounts and where they were on the statement cycle. Calls were then made to the accounts with the highest propensity to pay. Waiting on hold not only wastes a patient’s time but also leads to a frustrating patient experience. Many even abandon calls, to call again later, which makes phone lines even busier. To provide a better patient experience, the department was also able to try out an innovative recall campaign, enabled by the queue callback feature. Patients were called back automatically the moment an agent became available, thereby reducing call hold time. By providing patients with this callback option, Dayton Children’s is empowered to accept more inbound calls per day along with having empathetic conversations with guarantors around payment plans to sustain its collections goals. Patient scheduling and preregistration powered through automation The Pre-Service Operations department leveraged PatientDial to improve outbound call efficiency and optimize existing staff resources to schedule appointments rather than leave voicemails. The productivity for scheduling a new patient visit from an outbound call was about 30%. With the centralized team supporting more than 40 specialty clinics, the team needed to improve the number of new patient visits scheduled daily, which meant opening resources to receive inbound calls. The mighty team of 10 was able to strategically use the autodialer feature to make new appointments, send appointment reminders and schedule referrals. Time is of the essence in a healthcare setting, and swift access to pertinent patient information enabled the staff to start their work even before greeting the callers when an inbound call came. Powered by the agent pop feature, staff had immediate access to key patient identifiers such as name, date of birth and specialty clinic from referral. Additionally, the feature enabled the team to reinvest time in creating a positive patient experience through improved hold and talk times, both of which reduce the risk of call abandonment. Results of incorporating PatientDial With PatientDial, the Patient Accounts department has been able to successfully align revenue goals with employee productivity. Previously, the staff was able to make only 50–60 calls per day, out of which 70% went unanswered. By automating dialing, the staff is now able to make 600 calls per day, resulting in a corresponding uptick in collections. The recall campaign, used for following up with patient guarantors, was a new endeavor for the department and has reduced the staff’s burden of making 300 manual calls per day and has also reduced call abandonment rates. The Pre-Service Operations department, has seen a 50% increase in patient appointments scheduled, powered by 600–800 automated calls made per day. The referral-to-scheduled appointment timeline has gone down from 4 days to under 1 day. Two hundred patients can now be reached via text daily and the speed to answer calls has been reduced from 60 seconds to 30 seconds. Lastly, PatientDial has positively challenged the Pre-Service Operations department to rethink productivity and daily operational efficiency. Dayton Children’s investment in dialing automation has streamlined their patient communications around scheduling and far exceeded initial goals. Because of the resulting high volumes of new patients scheduled and improved efficiency and effectiveness the team realized, there’s a strategic plan specific to central scheduling and to implement standard processes for managing new patient referrals across the organization. What’s next for Dayton Children’s? Empowered by their stellar results, both the Patient Accounts and Pre-Service Operations departments want to further explore how PatientDial could help other departments achieve greater productivity and further deliver a positive patient experience. The Patient Accounts department wants to maintain its focus on productivity gains and employee experience through PatientDial, with the ultimate goal of bringing in more collections. The Pre-Service Operations department plans to take on additional scheduling responsibilities across departments, creating time to reinvest in direct patient care and improving patient outcomes. Initial plans are for establishing patient scheduling and improving processes to identify and schedule follow-up visits. Both the teams at Dayton Children's recognize Experian Health’s expertise in revenue cycle solutions, which has made this a successful partnership. Learn more about how PatientDial uses patient outreach and patient engagement processes and workflows to increase your bottom line.  

The COVID-19 pandemic has highlighted the need for a more responsive, flexible and resilient approach to revenue cycle management, underscored by provider staffing shortages across the country. Automation is gaining momentum as a way to address the staffing issue while improving efficiency and collections optimization to levels better than those prior to the pandemic. Furthermore, with the No Surprises Act effective as of January 1. 2022, automation and digital tools can help providers deliver transparent pricing with real-time cost estimates. With automated healthcare collections, providers can help patients plan for their healthcare costs. This is especially important, given that half of Americans currently have unpaid medical bills. In North Carolina, Novant Health is already seeing an impressive return on their investment in automated patient collections technology. The provider logged over 5.8 million medical encounters in 2020. Novant Health’s patient finance team wanted to address growth while continuing to deliver an improved patient financial experience. They wanted to automate workflows and processes to reduce the need for staff intervention, using a wide-ranging platform that would easily integrate with Epic and provide robust reporting and insights. Compiling agency performance reports for 21 agencies each month was another cumbersome task, so the team also wanted a partner who would help elevate and monitor agency performance. Watch our webinar with Novant Health to see how they used Collections Optimization Manager to increase patient collections and create better patient financial experiences. Delivering a “human experience” with the right patient collections partner Wendi Bennett, Director of Patient Finance at Novant Health, said it was important for them to find a strategic and collaborative partner who would understand their commitment to providing a remarkable patient experience: “The patient can have a wonderful clinical experience but face a financial experience that falls short of expectations," said Bennett. "We wanted a dedicated consultant who would recommend best practices and provide valuable industry insights, and a system with proven results in back-end automation, operational improvement and analytical performance. We were looking to propel our patient experience to the next level and that’s why we partnered with Experian Health.” Automated healthcare collections insights for a better patient experience and fewer unpaid medical bills Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, is the Collections Consultant who has been working with Wendi’s team to implement the Collections Optimization Manager. Cari explains how the Collections Optimization bundle delivers the data insights and execution support that Wendi and her team were looking for: “We’re able to extract data from the facility’s accounts receivable file and produce robust analytics and insights. That allows us to screen or scrub out those accounts that we should not be scoring or segmenting. Then, we shift to the customized segmentation which provides the client the ability to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.  Customized segmentation also gives the client the ability to keep the best, most collectible accounts in-house longer and give the lower yield accounts to their early out agency sooner. We drive revenue back in the door by focusing on these accounts. Finally, we monitor for new insights into patients’ propensity to pay. And with Collections Optimization Manager, our clients receive consultant support as part of the bundle, who provide best practices, insights and analysis throughout the relationship.” Highly predictive patient segmentation means that Novant Health knows which patients are most able to pay, those eligible for charitable support, and who should be directed to different payment plans. This supports more compassionate financial conversations and communications with patients. It also creates opportunities for personalized recommendations, such as reminding new parents to ensure their child is included on their healthcare insurance. The more transparency, simplicity and compassion that can be built-in, the easier the process will be for patients. For providers like Novant Health, that means fewer bills being written off. Efficient allocation of patient collections staff resources Collections Optimization Manager also allows providers like Novant Health to focus their efforts on the right accounts. It doesn’t make sense for staff to spend valuable time following up with patients who have a low co-pay amount and a high likelihood to pay. Simple automated reminders address that situation. The Novant Health team used automated dialer campaigns to reduce manual outbound calls and allocated limited staff resources to more complex accounts. A split-screen shows staff all the information they need during the call, eliminating the need to log into multiple systems at once. Call recordings stop automatically before the patient shares their credit card information, ensuring PCI compliance without extra steps. Keeping track of collections agency performance – and costs With Collections Optimization Manager, Novant Health can prioritize high propensity-to-pay accounts in-house, which helps to manage agency costs. A customized scorecard and dashboard keep track of agency benchmarks, giving the executive leadership team a real-time snapshot of performance, informing decisions about vendor management. The Compliance Manager function helps Novant Health ensure agency collections have compliance at top of mind and are not solely focused on the highest yield accounts. This function, combined with better segmentation and a higher call connection rate, results in higher recovery rates. With Collections Optimization Manager, Novant Health has seen a 5.8% increase in unit yield year-over-year, and an overall recovery rate of 6.5%. Overall increased revenue and cost savings amount to an impressive rolling average return on investment – 8.5:1. Watch the webinar to find out more about how Novant Health boosted its patient collections recovery rates with an automated healthcare collections platform. Find out more about how Collections Optimization Manager can help your organization use automation and digital tools to create a more efficient patient collections process and a more streamlined patient financial experience.

A little over a year ago, Experian Health surveyed healthcare providers for a snapshot of their views on the digitalization of patient access, and the importance of healthcare collections. At the start of the COVID-19 pandemic, patient collections emerged as a top priority, the result of rising unemployment and competing consumer demands that impeded patients’ ability to pay. By June 2021, provider attitudes had changed. Our follow-up State of Patient Access 2.0 survey revealed that patient collections were no longer the number one concern for healthcare providers. Patient perceptions of the billing process have improved too. In our latest Interview with the Expert, Matt Baltzer, Senior Director of Product Management at Experian Health, explains why providers feel more confident about patient collections. He also discusses how automated healthcare solutions can help providers shore up these gains and optimize healthcare collections – especially as consumer behavior returns to pre-pandemic patterns. Watch the interview below:   Why are healthcare collections no longer the number one concern for providers? In the six months between the two surveys, the number of providers saying they were “concerned or very concerned” about collecting payments from patients dropped from 50% to 41%. Baltzer explains that during this time, collection rates were relatively steady (when adjusted for volume), and providers received fewer calls about patient balances. Currently, the bigger concern for both providers and patients is to determine patients’ coverage status quickly and accurately. There are three main reasons for this shift. Firstly, multiple rounds of stimulus payments issued by the government helped consumers pay down their debts, including medical bills. Secondly, the pandemic caused a drop in consumer spending on travel, entertainment and dining out, which meant credit card usage was lower than pre-pandemic levels. Consumers had more cash available to pay healthcare bills. And thirdly, employment rates have started to recover. Around the time of the first survey, providers were faced with a surge in patients who had suddenly lost employer-based coverage, but as unemployment levels improve again, this is less of an issue. Those still affected by job losses have been able to access expanded government support, such as Medicaid. How should providers prepare as consumer spending returns to pre-pandemic levels? As Americans start to return to previous consumer habits and routines, household spending is likely to increase, which could squeeze medical bills again. Baltzer explains that “as we see stimulus programs winding down, and discretionary spending options increase, we can expect to see an increase in the utilization of revolving credit lines. For most consumers, that will mean it’s more difficult to meet unplanned out-of-pocket obligations.” Prior to the pandemic, a survey by the U.S. Federal Reserve found that 40% of Americans struggle to find $400 to pay for an unexpected bill. This means providers may not be able to rely on the steady collection rates seen in recent months. While efforts to improve transparency will help patients prepare for possible financial obligations, many providers are going further, implementing the right data, tools, and strategies to understand and address each consumer’s unique situation, making it as easy as possible for patients to pay. Baltzer says: “Data can help drive attention to the accounts with a higher likelihood to pay. This means you can identify those who just need a little more time to pay, and then help those truly in need of charity support. Things can change quickly, and having fresh, accurate data will be essential. Now is not the time to take our eyes off the ball, as the game may shift quickly.” With access to reliable and comprehensive consumer data and automated patient collections solutions, providers can tailor the patient experience according to individual needs and preferences. They can create a more empathetic financial experience, with upfront pricing estimates, personalized payment plans and flexible payment options. Not only will this be more desirable for patients, but it will also optimize healthcare collections, improve operational efficiency and increase the chances of more bills being settled in full. How can optimizing patient collections offset recent staffing challenges? Staffing shortages remain a growing challenge for healthcare providers. According to Baltzer, technology and automation can help ease the pressure on collections teams. He says, “Automation is key. Providers are being challenged to make the most of limited staff resources, especially for patient collections. It’s important to focus staff attention on the accounts most likely to pay. That means filtering out accounts that might be bankrupt or deceased and using automation for manual tasks – such as checking for charity eligibility or cleaning up patient records. Best-in-class providers are increasingly leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter.” Collections Optimization Manager can help organizations deploy a targeted approach to patient collections, using data and analytics to segment, screen and monitor accounts. By optimizing on the back end with user-friendly interfaces and efficient workflows, staff can focus their efforts on the accounts that need the most attention. On the front end, Patient Outreach solutions can help patients take control of their own financial journey with timely bill reminders and self-pay options, and requires minimal staff intervention. Automated text and IVR messages that connect directly to billing software ensure that more accounts are settled without adding to the organization’s headcount. Watch the full conversation, and download the State of Patient Access Survey 2.0, to find out more about how Experian Health can help your organization spot new opportunities to optimize healthcare collections.