Tag: Revenue Cycle Management

For healthcare providers, revenue cycle management has become more important than ever. Due to increasing complexity in the payer mix and patients encountering more out-of-pocket costs, revenue cycle directors are also finding management an uphill battle. To maximize their reimbursement rates, today’s healthcare providers must take control of revenue cycles, and that requires optimizing three particular areas: estimates, claims, and collections. However, this task is much bigger than one person or department to enforce. For success, revenue cycle directors require an array of reliable, automated solutions that allow leveraging a wide range of data and comprehensive analytics with minimal employee input. At Experian Health, we offer a variety of solutions that help optimize healthcare systems' revenue cycle management by simplifying the three key areas mentioned above. Unlock vital revenue cycle management capabilities With patients taking more responsibility for their medical costs, modern revenue cycles are most successful when tailored to patients. This includes providing accurate cost estimates upfront, making sure claims are clean before submitting, and prioritizing debt collection efforts where they are most successful. 1. Patient Estimates: providing accurate estimates early In our consumer-centric environment, patients expect a greater level of insight into the costs of medical procedures, preferably before receiving treatment. No one likes to be surprised months after treatment with medical bills that far exceed what they expected. In addition, state laws now require hospitals to provide more accurate patient estimates. For consistently accurate cost estimates, a healthcare provider must have a dependable price-generation process. For example, the estimates should incorporate a patient’s specific insurance information for accuracy. They should also be compared to the patient’s propensity to pay so a payment plan can immediately be set up, much like how financial institutions treat automobile loans. Patient Estimates, Experian’s price transparency tool, auto-populates much of the necessary data so healthcare providers can deliver accurate patient estimates as early as possible. In turn, consistently accurate cost estimates raise healthcare providers' chances of collecting revenue upfront and help avoid unnecessary headaches during the claims and collections processes. 2. Claim Scrubber: submitting clean claims The conflicts caused by denied claims are expensive to fix. Interactions with payers cost medical groups thousands of dollars per physician each year. Many of those interactions result directly from denied claims, which often stem from inaccurate data. Claims data can be edited in Experian Health's Claim Scrubber, which reviews each claim line by line and makes edits based on the platform's data. Claim Scrubber combines the data with general, payer, and patient-specific information to guarantee each claim is properly coded every time. 3. Collections Optimization Manager: collecting debt strategically and efficiently If a healthcare provider wants to redesign its collection processes to center around patients, it should rely less on random outbound calls and focus more on insight regarding each patient’s propensity to pay. The burden of collecting on past-due balances is a demanding task. It also reduces a healthcare provider's chances of successfully collecting bad debt. One of the most important reasons — among many — to consistently provide accurate estimates and claims is to make collecting debt more successful and less time-consuming. Granted, a healthcare provider can't expect to collect every single outstanding fee. However, by concentrating on patients who are able to pay, a much greater percentage can be collected. Furthermore, Experian Health's Collections Optimization Manager helps complete revenue cycle management by using in-depth collected data to identify patients who are most likely to pay their hospital bills. In turn, staff members can utilize their time and resources more efficiently by contacting these specific patients first. Like most companies, healthcare providers are beginning to realize that patient engagement is a top priority. With this elevated engagement comes the need for consistent price transparency for medical care. Luckily, Experian’s automated engagement solutions can help your healthcare system provide the increased transparency it needs while also optimizing its revenue cycle management.

In 2014, Sanford Health set out to improve its success rate in collecting past-due patient bills. The health system increased its in-house collections by more than $40 million, and in a single year, it sent 28.5 percent fewer collections to outside agencies. How did Sanford Health do it? The patient account team improved its collections process with a hybrid approach of new tools and new ideas for patients and employees alike. Create a transparent system to identify the highest-yielding accounts Collections Optimization Manager allows the team to better manage patient collections by finding the patients who can and will pay. This is a big win. The team avoids wasting time and other resources on low-yield accounts. More importantly, when patients need Sanford Health’s financial assistance and charity services, they get the compassionate care they deserve. Previously, Sanford Health manually tracked and called patients who were late paying their bills. It was a cumbersome collections process, and the team had no way to focus its efforts on those people with the propensity to pay. The Collections Optimization Manager’s analytical models use precise algorithms to create segmented groups according to those patients who would prefer to pay in full at a discount, those who would prefer to pay on an installment plan, and those who are likely to be eligible for financial or charity assistance. Seamlessly integrate the new tool with existing ones The team coupled the new optimization manager with PatientDial, which they were already using and which routes calls to patient account representatives based on segmentation and decreases the cost of the collections process. Integrating with other products made it possible for Sanford Health to build upon previous success and easily implement the optimization manager with limited intervention from its IT department. Sanford Health was already using two other Experian Health products as well. First, Claim Scrubber helps Sanford Health submit clean claims to insurance companies and other payers, thus reducing undercharges and denials, optimizing staff time, and improving cash flow. Contract Manager and Contract Analysis audit payer compliance so the patient accounts team is assured that collections align with contract terms. Couple new tools with fresh, simple ideas Patient Statements is the final tool Sanford Health had already implemented when it embarked on its journey to improve the patient collections process. But it went a step further by redesigning the cover page. Now, patients can easily understand their payment options, including prompt-pay discounts. Also, the health system instituted an employee incentive program, which rewards staff members for their collections performance. Sanford Health is the largest nonprofit rural healthcare system in the nation. It has 45 hospitals and 289 clinics in nine states and four countries. It employs more than 28,000 people, including more than 1,300 physicians in more than 80 specialties. As Sanford Health grew and acquired new services, it realized that it couldn’t rely on a purely manual process to handle its collections process. Collections Optimization Manager turned out to be a profitable and otherwise satisfying collections solution. Collecting past-due bills is about money. And any business — even one focused on health and healing like Sanford Health is — must turn some of its attention to making money. But collections can be about more than that. It can be about making patients happier. It can be about figuring out who needs your help and exactly what kind of help they need. That’s what Sanford Health focused on, and it paid off. Learn more about how Sanford Health improved its process and collections success rate. Read the case study.

Recent industry shifts, including the transition from volume- to value- based reimbursement, lower reimbursement and shrinking inpatient margins, increased bad debt due to high deductible health plans and other challenges, are causing undue stress for healthcare providers. It’s difficult for some organizations to manage complex reimbursement models or handle complex claims, so providers are often underpaid or write off revenue they are due. The cost to collect continues to rise when staff produces poor results or turnover is high. Additionally, hospital information system (HIS) conversions traditionally result in a backlog of accounts receivable (A/R), requiring incremental staff to support the conversion. 78% of CFOs are concerned about their revenue cycle platform capabilities for value-based payments and will outsource in lieu of investing in new technology.^ Experian Health's Revenue Cycle Services leverage Experian’s proprietary technologies and experienced staff to optimize revenue cycle management (RCM) performance to help you meet your financial goals, such as increasing A/R yield, lowering operating costs, and resolution of revenue leakage issues and denials. Contact us today to learn more about Experian Health’s Revenue Cycle Services.   ^2015 Black Book Survey

Reimbursement pressures and the real potential of changing regulations require that revenue cycle leaders leverage data and technology to be as efficient and nimble as possible to maximize net revenue, reduce denials, and lower operating costs. Shifting reimbursement models, complex benefit designs and limitations, increased patient responsibility, and growing regulatory pressures are driving near-constant change in the healthcare revenue cycle. Healthcare organizations that used to be paid by the encounter are adapting to emerging trends of also being selected, measured, and paid for how they perform and collaborate with other providers to improve outcomes. This value versus volume movement has forced hospitals, physicians, and other providers to focus on delivering high-quality, collaborative care at a lower cost while enhancing the patient experience, including efficiency and patient sensitivity in the revenue cycle. Experian Health’s Revenue Cycle Analytics provides visibility across the revenue cycle continuum, transforming operational and financial information into actionable insights. By tapping into Experian Health’s vast product workflow data and revenue cycle transactions, you can hone in to optimize specific workflows and compare your facility’s operations and processes against industry peers to make more informed business outcomes. Relevant data is presented for users based on responsibilities. With your internal data, we can Improve your workflows, operational performance, and financial results by leveraging your data across the revenue cycle, matching it, and analyzing the account across the various revenue cycle workflows and transactions Ensure accurate reimbursement by analyzing workflows and optimizing activities Create and monitor revenue cycle KPIs around pre-service, point-of-service, post service, denials, etc. to provide data points needed for process and financial optimization Provide comparative analysis and benchmarking that scores payer performance based on claim, rejections, denials, and exceptions Identify trends by drilling down to the staff, department, and service levels to uncover insightful details Maximize return on investment in Experian Health revenue cycle management products Enable the calculations of HFMA Map Keys and NAHAM Access keys for true peer-to-peer benchmarking With decades of Big Data experience, and as experts in gathering and securely managing huge quantities of data, Experian Health’s Revenue Cycle Analytics manages an unrivalled breadth and depth of data to help clients gain a deep understanding of people, businesses, places, economics, and health.  

During HIMSS17 in Orlando, Jason Wallis, Senior Vice President, Patient Access at Experian Health, sat down with IntrepidNOW to talk patient access and how Experian Health's solutions help providers across the revenue cycle. Excerpt below: "We have the eCare NEXT platform that drives a lot of our integration and patient access products. So anywhere from orders, all the way back to collecting payment from the patients, so right identity, checking eligibility, authorizations, medical necessity, patient estimates and then a tool to collect payment from that patient for those estimates. ...we’ve really taken this eligibility rail that has been pretty standard in the industry, and we’ve added a lot of content and innovation on top of those rails. So I almost call our clearing house a content network. So we drive more value in that transaction by normalizing, cleaning the data and enriching it with other data assets, so that downstream our clients and our products are better because of that advanced content. ...our integrated platform takes this data and be able to start chaining products together, and deliver back to the provider an exception based workflow that really has their staff only looking and working when something’s gone wrong. And the more we can automate around products and even products chaining off of other products, so eligibility to notice of admission, we are able to remove some of those manual single point solutions because it’s integrated in a single workflow." Listen to the full podcast Learn more about Experian Health's patient access solutions and eCare NEXT platform  

Last week, Experian Health announced the launch of Patient Schedule, an innovative new solution that allows for real-time integration across organizations to streamline active patient self-service appointment scheduling, powered by MyHealthDirect. During HIMSS17, Jason Kressel, SVP Product and Account Management of MyHealthDirect, sat down with IntrepidNOW for a discussion about online patient scheduling. Excerpt below: "I think healthcare organizations are recognizing that in order to be competitive that they have to offer services that patients are demanding. And so while offering online scheduling for patients is a different way for patients to access healthcare providers requiring a little bit of a change to the provider workflow, ultimately they’re seeing the value of doing that because patients are more adherent to the services that they are supposed to be obtaining, and they’re happier when they come into the physician’s office. So there’s definitely work that’s done with the healthcare organizations to explain the changes in workflow, and what it means to make online scheduling accessible for their communities. But at the end of the day I think they all recognize the value of offering those types of services and are slowly shifting to full adoption. ...So one of the things that we will be working on is, from that Experian patient portal once they have a patient engaged through that channel, allowing the patient to search for a provider and book an appointment directly from the Experian patient portal. Another example, Experian Health does a lot of work around order management, if a hospital creates an order for a service that should take place in an ambulatory setting, right now they can manage the order but they can’t schedule the appointment for that, so we’ll also be incorporating the ability to schedule directly from the Experian Health platform." Listen to the full podcast Read our press release, "Experian Health and MyHealthDirect team up to improve practice workflow with cloud-based patient scheduling across healthcare networks" Learn more about Patient Schedule  

Earlier this year, Experian Health joined forces with hc1.com to empower companies to recapture lost revenue, control costs and better serve patients. At HIMSS17, Brad Bostic, CEO of HC1 sat down with IntrepidNOW's Joe Lavelle to discuss this and healthcare industry trends. Excerpt below: "...our customers has really span medical laboratories, health systems and post-acute care providers. And the common challenge that these organizations face is that they’re so intensely focused on their internal clinical quality and processes and how do you code for things to make sure that they can get billed, that it’s difficult for them to rise up to the level of truly seeing the full picture of what they’re doing with their customers, and understanding holistically where do I have areas that I need to focus to be able to perform better financially? ...what we’ve done is we’ve really built this partnership to bring healthcare relationship management together with the best of Experian Health’s products in the eCare NEXT and payer alerts areas, and what eCare NEXT and payer alerts do in combination with our HIPAA compliant HC1 platform is that we’re able to bring this level of financial risk stratification to the picture, so that if I’m a lab I can see across all the different providers that are referring to me and all the different patients that are flowing through, where are the places where I might be exposed to where I might not get reimbursed? And it’s doing this on the front end of the process rather than having it be an unpleasant surprise later on in the process that you haven’t gotten paid." Listen to the full podcast Explore our revenue cycle management solutions

Jason Considine, Senior Vice President, Patient Collections & Engagement, with Experian Health, sat down with Joe Lavelle from IntrepidNOW at HIMSS17 to talk patient engagement. Excerpt: "I think hospitals have spent tons of money really customizing the clinical experience for the patient over the last really 10 years and if you go into any hospital large hospital in America today, you’re going to feel like your care has been customized for you. But when you exit the care delivery mechanism and you get into the billing process, I still see providers treating patients kind of in a one size fits all method, and that’s where I see a lot of patient engagement changing from a financial perspective is using the power of information like what Experian has. We know what a patient’s financial disposition is, whether they can pay their bill or not, whether they qualify for the hospital’s financial assistance mechanism or not, and we can be more proactive in building that relationship and sending them offers to pay their bill and customize those types of engagements more appropriately for that you unique patient’s needs. We are the Best in KLAS vendor for patient access solutions, the eCare NEXT products suite. We are very focused on taking those tools that have been adopted by providers across the United States and making them patient facing. And so we have portals that can be accessed from any mobile device and from a desktop or laptop, and give the patient the ability to shop for care using self-service estimates. Pay their bill online and set up new payment plans and really communicate with their providers in the mechanism in vehicles in which they want to do it." Listen to the full podcast Learn about our Collections and Patient Engagement solutions.

The future for patient engagement becomes more clear every time we go out and do focus groups with providers and their patients. And what we are hearing from our clients and providers is that 40% of all their patients are on charity and 40% are on payment plans. So you are looking at about 80% of their patients needing charity or payment plans. And a lot of that is manual processes inside of the provider. And we also heard from a lot of consumers and patients that there is confusion about how they can afford their care. Clearly the thing that is on the top of our minds given this rising out of pocket expenses, is how can we anticipate what a patient needs when they leave the hospital using the Experian credit data? And then how can we proactively reach out to that patient with something that could be an activation offer for their charity care or their payment plan immediately after their service? We feel is this is a much more compassionate approach than what happens today. Leveraging the Experian credit data to be more proactive and predictive is a much more compassionate approach that will shift the patient’s behavior instead of the scenario where that patient takes their statement for $500 and put it under the stack of their bills. That one size fits all approach is not going to work anymore. We are moving to a very personalized patient engagement strategy that is more aligned with the patients’ needs and then give the patient all the digital automation tools so they can go and automate it and be done with it very quickly and they can focus on their health. Listen to the complete podcast Learn about our Patient Engagement solutions